Objective To investigate if histogram analysis and visually assessed heterogeneity of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping can predict molecular subtypes of invasive breast cancers. Materials and Methods In this retrospective study, 91 patients with invasive breast carcinoma who underwent preoperative magnetic resonance imaging (MRI) with DWI at our institution were included. Two radiologists delineated a 2-D region of interest (ROI) on ADC maps in consensus. Tumors were also independently classified into low and high heterogeneity based on visual assessment of DWI. First-order statistics extracted through histogram analysis within the ROI of the ADC maps (mean, 10th percentile, 50th percentile, 90th percentile, standard deviation, kurtosis, and skewness) and visually assessed heterogeneity were evaluated for associations with tumor receptor status (ER, PR, and HER2 status) as well as molecular subtype. Results HER2-positive lesions demonstrated significantly higher mean (p=0.034), Perc50 (p=0.046), and Perc90 (p=0.040), with AUCs of 0.605, 0.592, and 0.652, respectively, than HER2-negative lesions. No significant differences were found in the histogram values for ER and PR statuses. Neither quantitative histogram analysis based on ADC maps nor qualitative visual heterogeneity assessment of DWI images was able to significantly differentiate between molecular subtypes, i.e., luminal A versus all other subtypes (luminal B, HER2-enriched, and triple negative) combined, luminal A and B combined versus HER2-enriched and triple negative combined, and triple negative versus all other types combined. Conclusion Histogram analysis and visual heterogeneity assessment cannot be used to differentiate molecular subtypes of invasive breast cancer.

中文翻译：

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弥散加权成像与直视扩散系数的直方图分析和视觉异质性在浸润性乳腺癌分子亚型的预测中。

目的探讨直方图分析和视觉评估的弥散加权成像（DWI）的表观弥散系数（ADC）映射异质性是否可以预测浸润性乳腺癌的分子亚型。资料和方法在这项回顾性研究中，我们纳入了91例在我院接受DWI术前磁共振成像（MRI）浸润性乳腺癌的患者。两位放射科医生一致同意在ADC图上划定二维感兴趣区域（ROI）。根据DWI的视觉评估，也将肿瘤分别分为低异质性和高异质性。通过直方图分析在ADC映射的ROI中提取的一阶统计信息（平均值，第10个百分位数，第50个百分位数，第90个百分位数，标准差，峰度，和偏度）和视觉评估的异质性，以评估与肿瘤受体状态（ER，PR和HER2状态）以及分子亚型的关系。结果HER2阳性病变的均值（p = 0.034），Perc50（p = 0.046）和Perc90（p = 0.040）显着高于HER2阴性病变，其AUC分别为0.605、0.592和0.652。ER和PR状态的直方图值未发现明显差异。基于ADC映射的定量直方图分析或DWI图像的定性视觉异质性评估均无法显着地区分分子亚型，即腔A与所有其他亚型（腔B，富含HER2的三重阴性），腔A和B组合与HER2富集和三阴性组合 以及三重负数与所有其他类型的总和。结论直方图分析和视觉异质性评估不能用于区分浸润性乳腺癌的分子亚型。