Diffusion weighted imaging of the breast: Performance of standardized breast tumor tissue selection methods in clinical decision making

M. Wielema*, P. E. Sijens, H. Dijkstra, G. H. De Bock, I. G. van Bruggen, J. E. Siegersma, E. Langius, R. M. Pijnappel, M. D. Dorrius, M. Oudkerk

*Corresponding author for this work

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In breast diffusion weighted imaging (DWI) protocol standardization, it is recently shown that no breast tumor tissue selection (BTTS) method outperformed the others. The purpose of this study is to analyze the feasibility of three fixed-size breast tumor tissue selection (BTTS) methods based on the reproducibility, accuracy and time-measurement in comparison to the largest oval and manual delineation in breast diffusion weighted imaging data.


This study is performed with a consecutive dataset of 116 breast lesions (98 malignant) of at least 1.0 cm, scanned in accordance with the EUSOBI breast DWI working group recommendations. Reproducibility of the maximum size manual (BTTS1) and of the maximal size round/oval (BTTS2) methods were compared with three smaller fixed-size circular BTTS methods in the middle of each lesion (BTTS3, 0.12 cm(3) volume) and at lowest apparent diffusion coefficient (ADC) (BTTS4, 0.12 cm(3); BTTS5, 0.24 cm(3)). Mean ADC values, intraclass-correlation-coefficients (ICCs), area under the curve (AUC) and measurement times (sec) of the 5 BTTS methods were assessed by two observers.


Excellent inter- and intra-observer agreement was found for any BTTS (with ICC 0.88-0.92 and 0.92-0.94, respectively). Significant difference in ADCmean between any pair of BTTS methods was shown (p =


The performance of fixed-size BTTS methods, as a potential tool for clinical decision making, shows equal AUC but shorter ADC measurement time compared to manual or oval whole lesion measurements. The advantage of a fixed size BTTS method is the excellent reproducibility. A central fixed breast tumor tissue volume of 0.12 cm(3) is the most feasible method for use in clinical practice.

Original languageEnglish
Article number0245930
Number of pages13
JournalPLoS ONE
Issue number1
Publication statusPublished - 25-Jan-2021


  • MRI

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