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Diffusion-Weighted Imaging of Mucinous Carcinoma of the Breast: Evaluation of Apparent Diffusion Coefficient and Signal Intensity in Correlation With Histologic Findings

¹ Departments of Radiology, Pathology, and Surgery, Kitasato University School of Medicine and Kitasato University Hospital, Sagamihara, Kanagawa, Japan.
² Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
³ Centre for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
⁴ Present address: Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa, 228-8555 Japan.

OBJECTIVE. The purposes of this study were to compare the apparent diffusion coefficient (ADC) of mucinous carcinoma of the breast with that of other breast tumors and to analyze correlations between signal intensity on diffusion-weighted images and the histologic features of mucinous carcinoma.

SUBJECTS AND METHODS. Two hundred seventy-six patients with 277 lesions, including 15 mucinous carcinomas (13 pure type, two mixed type), 204 other malignant tumors, and 58 benign lesions, were examined with 1.5-T MRI at b values of 0 and 1,500 s/mm². The correlations between cellularity and ADC, homogeneity of signal intensity on diffusion-weighted images, and histopathologic findings were analyzed. The difference was statistically significant (p < 0.05).

RESULTS. The mean ADC of mucinous carcinoma (1.8 ± 0.4 x 10^-3 mm²/s) was statistically higher than that of benign lesions (1.3± 0.3 x 10^-3 mm²/s) and other malignant tumors (0.9 ± 0.2 x 10^-3 mm²/s) (p < 0.001). The ADC of pure type mucinous carcinoma (1.8 ± 0.3 x 10^-3 mm²/s) was higher than that of mixed type mucinous carcinoma (1.2 ± 0.2 x 10^-3 mm²/s) (p < 0.001) and other histologic types (p > 0.05). The correlation between mean cellularity and the ADC of mucinous carcinoma was significant (_s = -0.754; p = 0.001). The homogeneity of signal intensity on diffusion-weighted images correlated with the homogeneity of histologic structures of mucinous carcinoma (p < 0.001; = 0.826).

CONCLUSION. Mucinous carcinoma can be clearly differentiated from other breast tumors on the basis of ADC. The low signal intensity of mucinous carcinoma on diffusion-weighted images appears to reflect the presence of mucin and low cellularity. High signal intensity on diffusion-weighted images may reflect the presence of fibrovascular bundles, increased cell density, or a combination of these features.

Keywords: ADC valve • breast • diffusion-weighted imaging • MRI • mucinous carcinoma of the breast

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