Evaluating Apparent Diffusion Coefficient (Adc) As a Non-Invasive Imaging Biomarker for Breast Cancer Prognosis: Correlation With Histopathological and Molecular Biomarkers Publisher



Kouhi R ; Faeghi F ; Guity M ; Jomleh H ; Shamooshaki A
Source: International Journal of Cancer Management Published:2026

Abstract

Background: This study evaluates the potential of apparent diffusion coefficient (ADC) values derived from diffusion-weighted imaging (DWI) as non-invasive imaging biomarkers for breast cancer prognosis, correlating them with key histopathological and molecular features. Objectives: To assess the diagnostic accuracy of (ADC values derived from diffusion-weighted MRI for predicting breast cancer prognostic factors by examining their correlation with histopathological and molecular markers, including ER/PR status, HER2 expression, Ki-67 index, tumor grade, size, and lymph node metastasis. Methods: In this prospective study, 35 consecutive patients with histologically confirmed breast cancer were recruited through the private radiology office in Tehran, Iran, between December 2017 and August 2018. All patients underwent breast MRI at Athari Imaging Center, Tehran, using a 1.5 T scanner including diffusion-weighted imaging sequences. Histopathology served as the reference standard for all imaging findings. Apparent diffusion coefficient values were measured from manually selected regions of interest and statistically analyzed for correlations with ER/PR, HER2, Ki-67, tumor grade, size, and lymph node status. No indeterminate or missing data were recorded. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic performance thresholds, and variability in diagnostic accuracy across biomarkers was assessed through AUC comparison. Results: Significantly lower ADC values were observed in tumors with lymph node metastasis (P = 0.016), high Ki-67 expression (P = 0.042), and positive ER/PR status (P = 0.031). ROC analysis demonstrated high diagnostic performance of ADC for identifying metastatic lymph nodes (AUC = 0.879), ER/PR-positive tumors (AUC = 0.864), and Ki-67-positive tumors (AUC = 0.837). No significant correlations were found between ADC and HER2 status, tumor grade, or size. Conclusions: Apparent diffusion coefficient values significantly correlate with key prognostic factors in breast cancer, including hormone receptor status, tumor proliferation, and lymph node involvement. These findings highlight ADC as a promising non-invasive diagnostic biomarker for early risk stratification and treatment planning. Larger multicenter studies are warranted to validate these results and support broader clinical application. Copyright © 2026, Kouhi et al.