Diffusion-weighted MRI characteristics associated with prognostic pathological factors and recurrence risk in invasive ER+/HER2- breast cancers

J Magn Reson Imaging. 2018 Jul;48(1):226-236. doi: 10.1002/jmri.25909. Epub 2017 Nov 27.


Background: Hormone receptor-positive breast cancer is the most common subtype; better tools to identify which patients in this group would derive clear benefit from chemotherapy are needed.

Purpose: To evaluate the prognostic potential of diffusion-weighted MRI (DWI) by investigating associations with pathologic biomarkers and a genomic assay for 10-year recurrence risk.

Study type: Retrospective.

Subjects: In all, 107 consecutive patients (from 2/2010 to 1/2013) with estrogen receptor (ER)-positive/HER2neu-negative invasive breast cancer who had the 21-gene recurrence score (RS) test (Oncotype DX, Genomic Health).

Field strength/sequence: Each subject underwent presurgical 3T breast MRI, which included DWI (b = 0, 800 s/mm2 ).

Assessment: Apparent diffusion coefficient (ADC) and contrast-to-noise ratio (CNR) were measured for each lesion by a fifth year radiology resident. Pathological markers (Nottingham histologic grade, Ki-67, RS) were determined from pathology reports. Medical records were reviewed to assess recurrence-free survival.

Statistical tests: RS was stratified into low (<18), moderate (18-30), and high (>30)-risk groups. Associations of DWI characteristics with pathologic biomarkers were evaluated by binary or ordinal logistic regression, as appropriate, with adjustment for multiple comparisons. Post-hoc comparisons between specific groups were also performed.

Results: ADCmean (odds ratio [OR] = 0.61 per 1 standard deviation [SD] increase, adj. P = 0.044) and CNR (OR = 1.76 per 1-SD increase, adj. P = 0.026) were significantly associated with increasing tumor grade. DWI CNR was also significantly associated with a high (Ki-67 ≥14%) proliferation rate (OR = 2.55 per 1-SD increase, adj. P = 0.026). While there were no statistically significant linear associations in ADC (adj. P = 0.80-0.85) and CNR (adj. P = 0.56) across all three RS groups by ordinal logistic regression, post-hoc analyses suggested that high RS lesions exhibited lower ADCmean (P = 0.037) and ADCmax (P = 0.004) values and higher CNR (P = 0.008) compared to lesions with a low or moderate RS.

Data conclusion: DWI characteristics correlated with tumor grade, proliferation index, and RS, and may potentially help to identify those with highest recurrence risk and most potential benefit from chemotherapy.

Level of evidence: 3 Technical Efficacy Stage 3 J. Magn. Reson. Imaging 2017.

Keywords: Oncotype DX 21-gene recurrence score; adjuvant chemotherapy; breast cancer; diffusion-weighted imaging (DWI); prognostic biomarker.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / therapeutic use
  • Biopsy
  • Breast Neoplasms / diagnostic imaging*
  • Diffusion Magnetic Resonance Imaging*
  • Disease-Free Survival
  • Estrogen Receptor alpha / metabolism*
  • Female
  • Follow-Up Studies
  • Genetic Predisposition to Disease
  • Humans
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Prognosis
  • Receptor, ErbB-2 / metabolism*
  • Retrospective Studies
  • Risk
  • Risk Factors


  • Antineoplastic Agents
  • ESR1 protein, human
  • Estrogen Receptor alpha
  • ERBB2 protein, human
  • Receptor, ErbB-2