Heterogeneity of Diffusion-Weighted Imaging in Tumours and the Surrounding Stroma for Prediction of Ki-67 Proliferation Status in Breast Cancer.

Breast tissue heterogeneity is related to risk factors that lead to more aggressive tumour growth and worse prognosis, yet such heterogeneity has not been well characterized. The aim of this study is to reveal the heterogeneous signal patterns of the apparent diffusion coefficient (ADC) of a tumour and its surrounding stromal tissue and to predict the Ki-67 proliferation status in oestrogen receptor (ER)-positive breast cancer patients. A dataset of 82 patients who underwent diffusion-weighted imaging (DWI) examination was collected. The ADC map was segmented into regions comprising the tumour and the surrounding stromal shells. To reflect correlations between each region in terms of its mean ADC value, a functional graph was constructed consisting of nodes as regions and edges as interactions between two nodes. Analysis of the graph revealed a higher average degree in samples over-expressing Ki-67 than in samples with low Ki-67 expression. In the low-Ki-67 group, most of the identified edges represented correlations between adjacent regions, whereas additional edges representing correlations between non-adjacent regions were found in the high-Ki-67 group. The ADC signal in various breast stromal regions surrounding the tumour showed a discriminative pattern and would be valuable for estimating the Ki-67 proliferation status by DWI.