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Peer-reviewedCC BY-NC 4.0Diagnostic and Interventional Radiology

Peritumoral-to-tumoral apparent diffusion coefficient ratio as a marker of tumor microenvironment activity across breast cancer molecular subtypes

  • Seçil Gündoğdu1
  • Eda Elverici1
  • Arzu Özsoy2
  • Leman Günbey Karabekmez3
  • Muhammed Said Beşler4
  • Emre Gündoğdu5
5 affiliations
  1. 1Ankara Bilkent City Hospital, Clinic of Radiology, Ankara, Türkiye
  2. 2Ankara Medipol University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
  3. 3Ankara Bilkent City Hospital, Yıldırım Beyazıt University, Department of Radiology, Ankara, Türkiye
  4. 4İstanbul Medeniyet University Faculty of Medicine, Department of Radiology, İstanbul, Türkiye
  5. 5Yüksek İhtisas University Faculty of Medicine, Department of Surgery, Ankara, Türkiye
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Abstract

PURPOSE: This study aimed to evaluate the prognostic significance of tumoral apparent diffusion coefficient (tADC), peritumoral ADC (pADC), and the peritumoral-to-tumoral ADC (p/tADC) ratio in invasive breast cancers using high-resolution diffusion-weighted imaging.

METHODS: A retrospective cohort of 149 patients with invasive breast cancer was analyzed. pADC, tADC, and p/tADC values were independently measured by two experienced radiologists. The associations between these parameters and histological grade, receptor status, Ki-67 index, and molecular subtypes were assessed. Interobserver agreement was evaluated using the intraclass correlation coefficient (ICC), and multivariate logistic regression was performed to identify independent predictors.

RESULTS: Although tADC was significantly associated only with tumor size (P < 0.050), both pADC and p/tADC were significantly associated with high histological grade, estrogen receptor/progesterone receptor negativity, human epidermal growth factor receptor 2 positivity, and high Ki-67 index(P < 0.01). The p/tADC ratio emerged as an independent predictor of high-grade tumors and Ki-67 ≥ 20%. Excellent interobserver agreement was observed for all ADC measurements (ICC > 0.90).

CONCLUSION: The p/tADC ratio reflects stromal and microenvironmental alterations associated with tumor aggressiveness and demonstrates stronger prognostic relevance than tADC alone. Incorporating the p/tADC ratio into routine magnetic resonance imaging (MRI) interpretation may improve preoperative risk stratification and support personalized treatment planning in invasive breast cancer.

CLINICAL SIGNIFICANCE: The p/tADC ratio reflects stromal and microenvironmental changes associated with tumor aggressiveness and may serve as a non-invasive imaging biomarker. Its integration into preoperative MRI protocols may facilitate risk stratification and personalized treatment planning.

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Cite

BibTeXRIS
BibTeX
@article{gundogdu2026peritumoraltotumoral,
  title = {{Peritumoral-to-tumoral apparent diffusion coefficient ratio as a marker of tumor microenvironment activity across breast cancer molecular subtypes}},
  author = {Seçil Gündoğdu and Eda Elverici and Arzu Özsoy and Leman Günbey Karabekmez and Muhammed Said Beşler and Emre Gündoğdu},
  journal = {Diagnostic and Interventional Radiology},
  year = {2026},
  month = nov,
  doi = {10.4274/dir.2026.263742},
  url = {https://doi.org/10.4274/dir.2026.263742},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Peritumoral-to-tumoral apparent diffusion coefficient ratio as a marker of tumor microenvironment activity across breast cancer molecular subtypes
AU  - Seçil Gündoğdu
AU  - Eda Elverici
AU  - Arzu Özsoy
AU  - Leman Günbey Karabekmez
AU  - Muhammed Said Beşler
AU  - Emre Gündoğdu
PY  - 2026
DA  - 2026/11/02
JO  - Diagnostic and Interventional Radiology
DO  - 10.4274/dir.2026.263742
UR  - https://doi.org/10.4274/dir.2026.263742
AB  - PURPOSE: This study aimed to evaluate the prognostic significance of tumoral apparent diffusion coefficient (tADC), peritumoral ADC (pADC), and the peritumoral-to-tumoral ADC (p/tADC) ratio in invasive breast cancers using high-resolution diffusion-weighted imaging.  METHODS: A retrospective cohort of 149 patients with invasive breast cancer was analyzed. pADC, tADC, and p/tADC values were independently measured by two experienced radiologists. The associations between these parameters and histological grade, receptor status, Ki-67 index, and molecular subtypes were assessed. Interobserver agreement was evaluated using the intraclass correlation coefficient (ICC), and multivariate logistic regression was performed to identify independent predictors.  RESULTS: Although tADC was significantly associated only with tumor size (P < 0.050), both pADC and p/tADC were significantly associated with high histological grade, estrogen receptor/progesterone receptor negativity, human epidermal growth factor receptor 2 positivity, and high Ki-67 index(P < 0.01). The p/tADC ratio emerged as an independent predictor of high-grade tumors and Ki-67 ≥ 20%. Excellent interobserver agreement was observed for all ADC measurements (ICC > 0.90).  CONCLUSION: The p/tADC ratio reflects stromal and microenvironmental alterations associated with tumor aggressiveness and demonstrates stronger prognostic relevance than tADC alone. Incorporating the p/tADC ratio into routine magnetic resonance imaging (MRI) interpretation may improve preoperative risk stratification and support personalized treatment planning in invasive breast cancer.  CLINICAL SIGNIFICANCE: The p/tADC ratio reflects stromal and microenvironmental changes associated with tumor aggressiveness and may serve as a non-invasive imaging biomarker. Its integration into preoperative MRI protocols may facilitate risk stratification and personalized treatment planning.
SN  - 1305-3825
SN  - 1305-3612
ER  -