Journal of Southern Medical University ›› 2025, Vol. 45 ›› Issue (9): 1809-1817.doi: 10.12122/j.issn.1673-4254.2025.09.01
Liying ZHANG(
), Tongzhen ZHANG, Xin ZHAO
Received:2025-04-09
Accepted:2025-05-17
Online:2025-09-20
Published:2025-09-28
Contact:
Liying ZHANG
E-mail:540185181@qq.com
Supported by:Liying ZHANG, Tongzhen ZHANG, Xin ZHAO. Diagnostic value of morphological features of breast lesions on DWI and T2WI assessed using Breast Imaging Reporting and Data System lexicon descriptors[J]. Journal of Southern Medical University, 2025, 45(9): 1809-1817.
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URL: https://www.j-smu.com/EN/10.12122/j.issn.1673-4254.2025.09.01
Fig.1 Flowchart of patient selection in this study.
Fig.2 A 38-year-old female patient with invasive ductal breast carcinoma in the left breast. A： Dynamic contrast-enhanced image shows a round uncircumscribed mass with rim enhancement in the left breast. B, C： Diffusion-weighted image （DWI） acquired by using a b value of 800 s/mm2 shows a round, circumscribed, and high-intensity mass. The internal pattern of combined assessment of DWI and apparent diffusion coefficient is considered a rim-like pattern. D： T2-weighted image reveals the corresponding lesion as a high-intensity area surrounded by a low-intensity rim.
Fig.3 A 58-year-old female patient with invasive ductal breast carcinoma in the left breast. A： The dynamic contrast-enhanced image shows a round circumscribed mass with rim enhancement in the left breast. B, C： DWI acquired by using a b value of 800 s/mm2 shows a round, circumscribed， and high-intensity mass. The internal pattern of combined assessment of DWI and apparent diffusion coefficient is considered a rim-like pattern. D： T2-weighted imaging reveals the corresponding lesion as a low-intensity area surrounded by a high-intensity rim.
Fig.4 A 34-year-old female patient with ductal carcinoma in situ in the left breast. A： The dynamic contrast-enhanced image shows a segmental non-mass lesion with clustered ring pattern enhancement in the left breast. B, C： DWI acquired by using a b value of 800 s/mm2 shows a segmental high-intensity non-mass lesion extending from the nipple to the chest wall region anteriorly. The internal pattern of combined assessment of DWI and apparent diffusion coefficient is considered a clustered ring pattern. D： T2-weighted imaging reveals the corresponding lesion as a segmental， heterogeneous, and slight high-intensity non-mass lesion.
| Variable | Malignant （n=299） | Benign （n=95） | |||
|---|---|---|---|---|---|
| Mass （n=239） | Non-mass （n=60） | Mass （n=82） | Non-mass （n=13） | ||
| Age （year, Mean±SD） | 48.8±9.8 | 50.5±10.6 | 37.9±11.5 | 35.2±9.0 | |
| Lesion size （mm, Mean±SD） | 25.8±13.1 | 53.6±20.8 | 23.7±11.8 | 49.6±24.4 | |
| Histological type | |||||
| Invasive ductal carcinoma | 210 | 36 | |||
| Invasive lobular carcinoma | 5 | 3 | |||
| Mucinous carcinoma | 7 | 0 | |||
| Papillary carcinoma | 7 | 2 | |||
| Apocrine carcinoma | 0 | 1 | |||
| Metaplastic carcinomas | 2 | 0 | |||
| Ductal carcinoma in situ | 8 | 18 | |||
| Fibroadenoma | 54 | 0 | |||
| Fibrocystic changes | 7 | 0 | |||
| Papilloma | 6 | 2 | |||
| Sclerosing adenosis | 4 | 1 | |||
| Phyllodes tumors | 6 | 0 | |||
| Inflammatory changes | 5 | 10 | |||
Tab.1 Clinicopathological characteristics of the patients
| Variable | Malignant （n=299） | Benign （n=95） | |||
|---|---|---|---|---|---|
| Mass （n=239） | Non-mass （n=60） | Mass （n=82） | Non-mass （n=13） | ||
| Age （year, Mean±SD） | 48.8±9.8 | 50.5±10.6 | 37.9±11.5 | 35.2±9.0 | |
| Lesion size （mm, Mean±SD） | 25.8±13.1 | 53.6±20.8 | 23.7±11.8 | 49.6±24.4 | |
| Histological type | |||||
| Invasive ductal carcinoma | 210 | 36 | |||
| Invasive lobular carcinoma | 5 | 3 | |||
| Mucinous carcinoma | 7 | 0 | |||
| Papillary carcinoma | 7 | 2 | |||
| Apocrine carcinoma | 0 | 1 | |||
| Metaplastic carcinomas | 2 | 0 | |||
| Ductal carcinoma in situ | 8 | 18 | |||
| Fibroadenoma | 54 | 0 | |||
| Fibrocystic changes | 7 | 0 | |||
| Papilloma | 6 | 2 | |||
| Sclerosing adenosis | 4 | 1 | |||
| Phyllodes tumors | 6 | 0 | |||
| Inflammatory changes | 5 | 10 | |||
| Parameter | DCE | DWI | T2WI | |||||
|---|---|---|---|---|---|---|---|---|
| ICC （95% CI） | Level of concordance | ICC （95% CI） | Level of concordance | ICC （95% CI） | Level of concordance | |||
| Mass-like lesions | ||||||||
| Shape | 0.908 （0.887-0.926） | Excellent | 0.910 （0.888-0.928） | Excellent | 0.941 （0.926-0.953） | Excellent | ||
| Margin | 0.890 （0.865-0.911） | Good | 0.837 （0.786-0.875） | Good | 0.759 （0.708-0.801） | Good | ||
| Internal patterns | 0.871 （0.841-0.895） | Good | 0.907 （0.886-0.925） | Excellent | 0.833 （0.796-0.864） | Good | ||
| Signal intensity | - | - | 0.897 （0.872-0.917） | Good | 0.934 （0.918-0.948） | Excellent | ||
| Non-mass-like lesions | ||||||||
| Distribution | 0.991 （0.985-0.994） | Excellent | 0.824 （0.734-0.886） | Good | 0.791 （0.687-0.863） | Good | ||
| Internal patterns | 0.789 （0.684-0.862） | Good | 0.844 （0.763-0.899） | Good | 0.802 （0.703-0.871） | Good | ||
| Signal intensity | - | - | 0.834 （0.748-0.892） | Good | 0.846 （0.765-0.900） | Good | ||
Tab.2 Interclass correlation coefficient （ICC） for the qualitative parameters analyzed
| Parameter | DCE | DWI | T2WI | |||||
|---|---|---|---|---|---|---|---|---|
| ICC （95% CI） | Level of concordance | ICC （95% CI） | Level of concordance | ICC （95% CI） | Level of concordance | |||
| Mass-like lesions | ||||||||
| Shape | 0.908 （0.887-0.926） | Excellent | 0.910 （0.888-0.928） | Excellent | 0.941 （0.926-0.953） | Excellent | ||
| Margin | 0.890 （0.865-0.911） | Good | 0.837 （0.786-0.875） | Good | 0.759 （0.708-0.801） | Good | ||
| Internal patterns | 0.871 （0.841-0.895） | Good | 0.907 （0.886-0.925） | Excellent | 0.833 （0.796-0.864） | Good | ||
| Signal intensity | - | - | 0.897 （0.872-0.917） | Good | 0.934 （0.918-0.948） | Excellent | ||
| Non-mass-like lesions | ||||||||
| Distribution | 0.991 （0.985-0.994） | Excellent | 0.824 （0.734-0.886） | Good | 0.791 （0.687-0.863） | Good | ||
| Internal patterns | 0.789 （0.684-0.862） | Good | 0.844 （0.763-0.899） | Good | 0.802 （0.703-0.871） | Good | ||
| Signal intensity | - | - | 0.834 （0.748-0.892） | Good | 0.846 （0.765-0.900） | Good | ||
| Lesion type | DCE | P | DWI | P | T2WI | P | |||
|---|---|---|---|---|---|---|---|---|---|
| Benign | Malignant | Benign | Malignant | Benign | Malignant | ||||
| Mass-like lesions （n=321） | |||||||||
| Shape | |||||||||
| Oval | 33 （40.2） | 17 （7.1） | <0.001 | 34 （41.5） | 27 （11.3） | <0.001 | 33 （40.2） | 19 （7.9） | <0.001 |
| Round | 28 （34.1） | 115 （48.1） | 29 （35.4） | 111 （46.4） | 30 （36.6） | 120 （50.2） | |||
| Irregular | 21 （25.6） | 107 （44.8） | 19 （23.2） | 101 （42.3） | 19 （23.2） | 100 （41.8） | |||
| Margin | |||||||||
| Circumscribed | 48 （58.5） | 59 （24.7） | <0.001 | 50 （61.0） | 100 （41.8） | 0.003 | 49 （59.8） | 63 （26.4） | <0.001 |
| Not circumscribed | 34 （41.5） | 180 （75.3） | 32 （39.0） | 139 （58.2） | 33 （40.2） | 176 （73.6） | |||
| Internal patterns | |||||||||
| Homogeneous | 11 （13.4） | 25 （10.5） | <0.001 | 17 （20.7） | 43 （18.0） | <0.001 | 23 （28.0） | 69 （28.9） | <0.001 |
| Heterogeneous | 62 （75.6） | 131 （54.8） | 60 （73.2） | 127 （53.1） | 57 （69.5） | 119 （49.8） | |||
| Rim | 9 （11.0） | 83 （34.7） | 5 （6.1） | 69 （28.9） | 2 （2.4） | 51 （21.3） | |||
| Signal intensity | |||||||||
| Low-Iso | - | - | - | 6 （7.3） | 0 （0） | <0.001 | 19 （23.2） | 95 （39.7） | 0.002 |
| Slightly high | - | - | 10 （12.2） | 9 （3.8） | 9 （11.0） | 41 （17.2） | |||
| High | - | - | 66 （80.5） | 230 （96.2） | 54 （65.9） | 103 （43.1） | |||
| Non-mass-like lesions （n=73） | |||||||||
| Distribution | |||||||||
| Focal | 3 （23.1） | 6 （10.0） | 0.153 | 3 （23.1） | 6 （10.0） | 0.085 | 3 （23.1） | 8 （13.3） | 0.134 |
| Segmental | 5 （38.5） | 32 （53.3） | 4 （30.8） | 31 （51.7） | 4 （30.8） | 29 （48.3） | |||
| Regional | 5 （38.5） | 13 （21.7） | 6 （46.2） | 14 （23.3） | 6 （46.2） | 14 （23.3） | |||
| Diffuse | 0 （0） | 9 （15.0） | 0 （0） | 9 （15.0） | 0 （0） | 9 （15.0） | |||
| Internal patterns | |||||||||
| Homogeneous | 0 （0） | 1 （1.7） | 0.171 | 0 （0） | 0 （0） | 0.289 | 0 （0） | 1 （1.7） | 1.0 |
| Heterogeneous | 8 （61.5） | 50 （83.3） | 11 （84.6） | 56 （93.3） | 13 （100.0） | 58 （96.7） | |||
| Clumped/clustered ring | 5 （38.5） | 9 （15.0） | 2 （15.4） | 4 （6.7） | 0 （0） | 1 （1.7） | |||
| Signal intensity | |||||||||
| Low-Iso | - | - | - | 2 （15.4） | 2 （3.3） | 0.036 | 6 （46.2） | 27 （45.0） | 0.608 |
| Slightly high | - | - | 5 （38.5） | 11 （18.3） | 6 （46.2） | 21 （35.0） | |||
| High | - | - | 6 （46.2） | 47 （78.3） | 1 （7.7） | 12 （20.0） | |||
Tab.3 Comparison between benign and malignant lesions for qualitative imaging findings with DCE， DWI and T2WI sequences (［n （%）］)
| Lesion type | DCE | P | DWI | P | T2WI | P | |||
|---|---|---|---|---|---|---|---|---|---|
| Benign | Malignant | Benign | Malignant | Benign | Malignant | ||||
| Mass-like lesions （n=321） | |||||||||
| Shape | |||||||||
| Oval | 33 （40.2） | 17 （7.1） | <0.001 | 34 （41.5） | 27 （11.3） | <0.001 | 33 （40.2） | 19 （7.9） | <0.001 |
| Round | 28 （34.1） | 115 （48.1） | 29 （35.4） | 111 （46.4） | 30 （36.6） | 120 （50.2） | |||
| Irregular | 21 （25.6） | 107 （44.8） | 19 （23.2） | 101 （42.3） | 19 （23.2） | 100 （41.8） | |||
| Margin | |||||||||
| Circumscribed | 48 （58.5） | 59 （24.7） | <0.001 | 50 （61.0） | 100 （41.8） | 0.003 | 49 （59.8） | 63 （26.4） | <0.001 |
| Not circumscribed | 34 （41.5） | 180 （75.3） | 32 （39.0） | 139 （58.2） | 33 （40.2） | 176 （73.6） | |||
| Internal patterns | |||||||||
| Homogeneous | 11 （13.4） | 25 （10.5） | <0.001 | 17 （20.7） | 43 （18.0） | <0.001 | 23 （28.0） | 69 （28.9） | <0.001 |
| Heterogeneous | 62 （75.6） | 131 （54.8） | 60 （73.2） | 127 （53.1） | 57 （69.5） | 119 （49.8） | |||
| Rim | 9 （11.0） | 83 （34.7） | 5 （6.1） | 69 （28.9） | 2 （2.4） | 51 （21.3） | |||
| Signal intensity | |||||||||
| Low-Iso | - | - | - | 6 （7.3） | 0 （0） | <0.001 | 19 （23.2） | 95 （39.7） | 0.002 |
| Slightly high | - | - | 10 （12.2） | 9 （3.8） | 9 （11.0） | 41 （17.2） | |||
| High | - | - | 66 （80.5） | 230 （96.2） | 54 （65.9） | 103 （43.1） | |||
| Non-mass-like lesions （n=73） | |||||||||
| Distribution | |||||||||
| Focal | 3 （23.1） | 6 （10.0） | 0.153 | 3 （23.1） | 6 （10.0） | 0.085 | 3 （23.1） | 8 （13.3） | 0.134 |
| Segmental | 5 （38.5） | 32 （53.3） | 4 （30.8） | 31 （51.7） | 4 （30.8） | 29 （48.3） | |||
| Regional | 5 （38.5） | 13 （21.7） | 6 （46.2） | 14 （23.3） | 6 （46.2） | 14 （23.3） | |||
| Diffuse | 0 （0） | 9 （15.0） | 0 （0） | 9 （15.0） | 0 （0） | 9 （15.0） | |||
| Internal patterns | |||||||||
| Homogeneous | 0 （0） | 1 （1.7） | 0.171 | 0 （0） | 0 （0） | 0.289 | 0 （0） | 1 （1.7） | 1.0 |
| Heterogeneous | 8 （61.5） | 50 （83.3） | 11 （84.6） | 56 （93.3） | 13 （100.0） | 58 （96.7） | |||
| Clumped/clustered ring | 5 （38.5） | 9 （15.0） | 2 （15.4） | 4 （6.7） | 0 （0） | 1 （1.7） | |||
| Signal intensity | |||||||||
| Low-Iso | - | - | - | 2 （15.4） | 2 （3.3） | 0.036 | 6 （46.2） | 27 （45.0） | 0.608 |
| Slightly high | - | - | 5 （38.5） | 11 （18.3） | 6 （46.2） | 21 （35.0） | |||
| High | - | - | 6 （46.2） | 47 （78.3） | 1 （7.7） | 12 （20.0） | |||
| Evaluation metrics | Mass-like lesions | Non-mass-like lesions | |||
|---|---|---|---|---|---|
| DCE | DWI | T2WI | DCE+DWI+T2WI | DWI | |
| Sensitivity （%） | 81.2 | 74.1 | 73.6 | 74.9 | 78.3 |
| Specificity （%） | 67.1 | 73.2 | 72.0 | 85.4 | 53.8 |
| PPV （%） | 87.8 | 88.9 | 88.4 | 93.7 | 88.7 |
| NPV （%） | 55.0 | 49.2 | 48.4 | 53.8 | 35.0 |
| Accuracy （%） | 77.6 | 73.8 | 73.2 | 77.6 | 74.0 |
| AUC （95% CI） | 0.786 （0.728-0.844） | 0.793 （0.735-0.850） | 0.809 （0.755-0.864） | 0.865 （0.816-0.914） | 0.669 （0.514-0.823） |
Tab.4 Diagnostic performance of the different prediction models for evaluating benign and malignant mass-like and non-mass-like lesions
| Evaluation metrics | Mass-like lesions | Non-mass-like lesions | |||
|---|---|---|---|---|---|
| DCE | DWI | T2WI | DCE+DWI+T2WI | DWI | |
| Sensitivity （%） | 81.2 | 74.1 | 73.6 | 74.9 | 78.3 |
| Specificity （%） | 67.1 | 73.2 | 72.0 | 85.4 | 53.8 |
| PPV （%） | 87.8 | 88.9 | 88.4 | 93.7 | 88.7 |
| NPV （%） | 55.0 | 49.2 | 48.4 | 53.8 | 35.0 |
| Accuracy （%） | 77.6 | 73.8 | 73.2 | 77.6 | 74.0 |
| AUC （95% CI） | 0.786 （0.728-0.844） | 0.793 （0.735-0.850） | 0.809 （0.755-0.864） | 0.865 （0.816-0.914） | 0.669 （0.514-0.823） |
Fig.5 Receiver operating characteristic （ROC） curves of the different prediction models for evaluating benign and malignant mass-like and non-mass-like lesions.
| Model | DCE | DWI | T2WI | DCE+DWI+T2WI |
|---|---|---|---|---|
| DCE | N/A | 0.837 | 0.293 | 0.001 |
| DWI | - | N/A | 0.522 | <0.001 |
| T2WI | - | - | N/A | 0.001 |
Tab.5 P-values for comparisons of areas under the curve between different mass-like lesion prediction models
| Model | DCE | DWI | T2WI | DCE+DWI+T2WI |
|---|---|---|---|---|
| DCE | N/A | 0.837 | 0.293 | 0.001 |
| DWI | - | N/A | 0.522 | <0.001 |
| T2WI | - | - | N/A | 0.001 |
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