Work

Reducing breast biopsy at MRI: comparison of minimum ADC cutoff and mean ADC cutoff identified by the ECOG-ACRIN A6702 multicenter trial

Year: 2025

Type: article

Abstract: The aim of this study was to validate the generalisability of the ECOG-ACRIN A6702 multicenter trial identified mean apparent diffusion coefficient (ADC) cutoff (1.53 × 10 − 3 mm 2 /s) and compare its biopsy reduction efficacy against a data-derived ADC minimum (ADC min ) cutoff. This dual-cohort retrospective analysis included 453 patients with 494 BI-RADS 4/5 lesions (derivation cohort: 288 patients/311 lesions; validation: 165 patients/183 lesions). ADC min and mean ADC (ADC mean ) were measured, the data-derived ADC min cutoff was optimised via an ROC analysis (negative likelihood ratio ≤ 0.1) .Performance metrics included biopsy reduction rates, sensitivity, and false-negative rates, stratified by lesion type, size, BI-RADS category, and field strength. In the derivation cohort, the data-derived ADC min cutoff (1.39 × 10 − 3 mm 2 /s) showed comparable performance to the A6702 ADC mean (ADC ACRIN ) cutoff in overall (24.7% vs. 24.1%), benign (47.9% vs. 45.1%) biopsy reduction and sensitivity (95.2% vs. 95.2%, all P > 0.05), with its robustness confirmed by the validation cohort (26.2% overall, 57.9% benign reduction, 96.3% sensitivity). Both cutoffs exhibited field strength dependency, with higher biopsy reduction at 1.5T vs. 3.0T (derivation: 30.1% vs. 17.8% for ADC min , P = 0.01; validation: 28.7% vs.17.5% for ADC min ). The data-derived ADC min cutoff (1.39 × 10 − 3 mm 2 /s) demonstrated non-inferiority to the ADC ACRIN cutoff in biopsy reduction while preserving sensitivity. Observed performance variations between 1.5T and 3.0T suggest that field strength and other technical factors may influence cutoff efficacy. Prospective multicenter studies with standardized protocols are needed to validate its generalisability and clarify the role of field strength.

Source: BMC Cancer

DOI: 10.1186/s12885-025-15282-7