The Contribution of MR Spectroscopy to the Diagnosis of BIRADS 4 and 5 Breast Lesions

INTRODUCTION: Breast cancer is the most frequently diagnosed type of cancer worldwide. Magnetic resonance spectroscopy (MRS) is a diagnostic method that non-invasively measures metabolite levels in tissues and analyzes their biochemical composition. In this study, we aimed to examine the choline metabolite levels in patients with BIRADS category 4 and 5 breast lesions through MRS performed before biopsy.
METHODS: We included 30 female patients with lesions detected in examinations, ultrasonography, or mammography and performed dynamic contrast-enhanced breast magnetic resonance imaging (MRI), diffusion-weighted imaging, and MRS. We compared the conventional findings of breast masses on MRI with histopathological results and choline level measurements separately.
RESULTS: Although the median choline level in the malignant group was clinically found to be higher compared to the benign group, there was no significant difference between the groups (p=0.473). The area under the ROC curve was 0.580 (95% Confidence Interval: 0.369–0.792), indicating that choline levels were not statistically significantly predictive (p=0.454). Among all cases, there was no correlation between choline levels and tumor diameter, minimum, mean, and maximum ADC measurements (p>0.05). The choline levels in the HER-2 positive group were higher compared to the HER-2 negative group (p=0.009).
DISCUSSION AND CONCLUSION: Although the choline level was found to be higher in malignant breast lesions, there was no statistically significant correlation. It is evident that interpreting MRS data in conjunction with morphological data is much more valuable than evaluating it alone.