Distinguishing benign and malignant breast tumors: Preliminary comparison of kinetic modeling approaches using multi-institutional dynamic contrast-enhanced MRI data from the International Breast MR Consortium 6883 trial

Comparative preliminary analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data collected in the International Breast MR Consortium 6883 multicenter trial was performed to distinguish benign and malignant breast tumors. Prebiopsy DCE-MRI data from 45 patients with suspicious breast lesions were obtained. Semiquantitative mean signal-enhancement ratio (SERmean) was calculated for all lesions, and quantitative pharmacokinetic, parameters Ktrans, kep, and ve, were calculated for the subset with available T1 maps (n=35). Diagnostic performance was estimated for DCE-MRI parameters and compared to standard clinical MRI assessment. Quantitative and semiquantitative metrics discriminated benign and malignant lesions, with receiver operating characteristic area under the curve (AUC) values of 0.71, 0.70, and 0.82 for Ktrans, kep, and SERmean, respectively (p<0.05). At equal 94% sensitivity, the specificity and positive predictive value of SERmean (53% and 63%, respectively) and K trans (42% and 58%) were higher than clinical MRI assessment (32% and 54%). A multivariable model combining SERmean and clinical MRI assessment had an AUC value of 0.87. Quantitative pharmacokinetic and semiquantitative analyses of DCE-MRI improves discrimination of benign and malignant breast tumors, with our findings suggesting higher diagnostic accuracy using SERmean. SERmean has potential to help reduce unnecessary biopsies resulting from routine breast imaging.