Role of Diffusion-Weighted Imaging in Differentiation Between Benign and Malignant Breast Lesions with Pathological Correlation

In diagnostic imaging, accurately differentiating benign from malignant breast lesions is still a significant issue. Measurements of the apparent diffusion coefficient (ADC) and diffusion-weighted imaging (DWI) have become essential noninvasive methods to improve breast MRI diagnostic accuracy. This aimed to detect the role of DWI in differentiation between benign and malignant breast lesions in correlation with pathological examination in comparison with full MRI protocol. This prospective study included 38 females with sono-mammographically detected breast lesions underwent MRI examination. Lesions were evaluated using DWI and ADC mapping. The imaging results were associated with histological diagnosis. The study was conducted between October 2021 and October 2022 at the Radiology Department of Mansoura University Hospitals in Egypt. The study group's mean age was 45.16 ± 11.65 years. DWI revealed restricted diffusion in all malignant lesions (100%) and only 7.1% of benign ones (p < 0.001). Malignant lesions had a mean ADC value of 0.809 ± 0.120 × 10⁻³ mm²/s, which was significantly lower than that of benign lesions (1.604 ± 0.326 × 10⁻³ mm²/s, p < 0.001). Restricted DWI achieved 100% sensitivity, 92.9% specificity, and 94.7% accuracy for malignancy detection. ROC analysis of ADC values showed an AUC of 0.955, with an optimal cutoff point of < 0.985 × 10⁻³ mm²/s. The DWI and ADC have a great diagnostic accuracy of measurements in distinguishing benign from malignant breast tumors. The quantitative ADC measurement can serve as a noninvasive, reliable biomarker complementing MRI-BIRADS assessment, boosting diagnostic confidence and perhaps minimizing needless biopsies.