Malignancy of breast lesions on diffusion weighted images

Purpose	Detect breast lesions and determine malignancy of breast lesions on diffusion weighted images using ADC values
Tag(s)
Panel	Breast Imaging
Define-AI ID	19060010
Originator	Vandana Dialani
Lead	Vandana Dialani
Panel Chair	Elizabeth Burnside
Panel Reviewers	Breast Imaging
License	Creative Commons 4.0
Status	Public Comment
RadElement Set	RDES132

Value Proposition

Breast MRI is commonly used to detect and diagnose breast cancer, though there are some limitations with T1/T2 weighted images to describe lesions. Use of diffusion in triaging biopsies would be more robust with AI and could help reduce biopsies and increase specificity of breast MRI, thus reducing overdiagnosis.

In addition the current application of DWI is in staging, and evaluation of treatment response. The lower the ADC values the higher the grade of IDC. AI could bring uniformity in obtaining to ADC values and improve the specificity of DWI — empowering its use as a non contrast MRI noninferior to DCE MRI. Eventually DWI could be widely utilized as a non contrast screening modality.

Narrative(s)

Patient has a breast mass which is indeterminate on MRI( Birads 4a or 4b) and biopsy recommended. With this technique clinician could increase specificity of masses which undergo biopsy and potentially save some biopsies.

Workflow Description

The image is obtained from modality and sent to PACS and the AI engine. The image is analyzed by the engine. The system then detects breast lesion and estimates malignancy. An alert message is sent to PACS from the engine with the information, identification, and graphic highlighting the malignant components.

Diagnostic MRI
1) Breast mass indeterminate on MRI( Birads 4a, 4b, 4c) and biopsy recommended.
2) Patient on neoadjuvant chemotherapy, adc obtained at different points of treatment for assessing treatment response

Screening MRI
1) identify breast lesion/ breast cancer
2) obtain adc maps/values

Age	>30 years
malignant lesion	invasive ductal carcinomas, Ductal carcinoma in situ, invasive lobular carcinoma, lobular carcinoma in situ, angiosarcomas, inflammatory breast cancer, paget disease of the breast, phyllodes tumors
Lesion size	varied

Inputs

  

DICOM Study

Procedure	Diffusion weighted MRI
Views	axial, coronal, sagittal
Data Type	DICOM
Modality	MR
Body Region	Chest
Anatomic Focus	Breast
Pharmaceutical	N/A
Scenario	Diffusion weighted MRI

Primary Outputs

Malignant breast lesion detection

RadElement ID	RDE872
Definition	Detection of malignant breast lesion
Data Type	Categorical
Value Set	Benign Lesion Malignant Lesion Unknown
Units	N/A

ADC values on ROI

RadElement ID	RDE873
Definition	ADC value on ROI
Data Type	Numeric
Value Set	N/A
Units	mm2/s

Segment the malignant component of a lesion

The Cancer Imaging Archive (TCIA)

QIN-Breast	TCGA-BRCA
QIN-BREAST-02	QIN-SARCOMA
Brain-Tumor-Progression	QIN Breast DCE-MRI
Mouse-Astrocytoma	Breast Diagnosis
ISPY1 (ACRIN 6657)	RIDER Breast MRI
Breast-MRI-NACT-Pilot	REMBRANDT
RIDER Neuro MRI

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