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25

J Gandhara Med Dent Sci

October - December 2026

ORIGINAL ARTICLE

How to cite this article

:

DIAGNOSTIC ACCURACY OF DYNAMIC CONTRAST-ENHANCED MRI FOR BREAST LESIONS

USING HISTOPATHOLOGY AS THE GOLD STANDARD

Mian Waheed Ahmad

1

, Maemoona Tahira

2

, Muqaddas Fatima

2

, Maryam Anayatullah

2

, Zahid Raheem Shah

2

,

Areeba Rashid

2

ABSTRACT

OBJECTIVES

This study aimed to determine the diagnostic accuracy of dynamic contrast-

enhanced magnetic resonance imaging (DCE-MRI) for diﬀerentiating benign

and malignant breast lesions, using histopathology as the reference standard.

METHODOLOGY

This

cross-sectional

diagnostic-accuracy

study

was

conducted

at

DHQ

Hospital, Gujranwala, Pakistan, from November 2023 to April 2024. Ninety-

six

patients

with

clinically

suspected

breast

lesions

were

enrolled

by

non-

probability

consecutive

sampling.

DCE-MRI

was

performed

before

histopathological

examination

by

biopsy

or

surgical

excision.

Sensitivity,

speciﬁcity,

predictive values, overall accuracy, and the association between

MRI and histopathological diagnosis were analyzed using SPSS version 26.

RESULTS

The mean age of participants was 45.52 ± 12.73 years, and histopathology

conﬁrmed

malignancy

in

54/96

(56.3%)

lesions.

DCE-MRI

showed

a

sensitivity of 90.7%, speciﬁcity of 83.3%, positive predictive value of 87.5%,

negative

predictive

value

of

87.5%,

and

overall

accuracy

of

87.5%.

MRI

diagnosis

was

strongly

associated

with

histopathology

(

χ

²

=

53.33,

p

<

0.001; Cramer's V = 0.745).

CONCLUSION

DCE-MRI demonstrated high diagnostic accuracy for diﬀerentiating benign

and

malignant

breast

lesions

and

may

serve

as

a

valuable

adjunct

in

the

evaluation of suspicious lesions.

KEYWORDS:

Breast Neoplasms; Diagnostic Accuracy; Dynamic Contrast-

Enhanced

Magnetic

Resonance

Imaging;

Histopathology;

Magnetic

Resonance Imaging

Ahmad MW, Tahira M, Fatima M,

Anayatullah M, Shah ZR, Rashid A.

Diagnostic Accuracy of Dynamic

Contrast-Enhanced MRI for Breast

Lesions using Histopathology as the

Gold Standard. J Gandhara Med Dent

Sci. 2026;13(4): 25-29.

Date Submission:

16-07-2026

Date Revised:

04-09-2026

Date Acceptance:

05-09-2026

2

Resident, Department of Radiology,

Gujranwala Teaching Hospital

Correspondence

1

Mian Waheed Ahmad,

Associate

Professor, Department of Radiology,

Gujranwala Teaching Hospital,

+92-333-4383045

drmianwaheedahmad@gmail.com

INTRODUCTION

Breast cancer is one of the most commonly diagnosed

malignancies in

women and remains a major cause of

cancer-related

morbidity

and

mortality

worldwide.

1

Early detection and accurate characterization of breast

lesions

are

important

for

guiding

management

and

improving

outcomes.

2

Mammography

and

ultrasonography are central to initial breast assessment

but

may

have

limitations

in

lesion

characterization,

particularly in dense breast tissue.

3

Magnetic resonance

imaging

(MRI)

provides

excellent

soft-tissue

contrast

together with anatomical and functional information.

4,5

Dynamic contrast-enhanced MRI (DCE-MRI) evaluates

lesion

vascularity

and

enhancement

kinetics

after

contrast

administration,

thereby

supporting

diﬀerentiation

of

benign

and

malignant

lesions.

6

Its

high sensitivity has led to increasing use as an adjunct

when

conventional

imaging

is

inconclusive

or

when

further

lesion

characterization

is

required.

7,8

Morphological

characteristics

and

enhancement

patterns

on

breast

MRI

can

contribute

to

diagnostic

discrimination.

9,10,11

Features such as irregular margins,

heterogeneous or rim enhancement, and rapid contrast

uptake

may

raise

suspicion

for

malignancy.

Standardized

reporting

through

the

Breast

Imaging

Reporting

and

Data

System

(BI-RADS)

has

further

improved

consistency

in

breast

MRI

interpretation.

Histopathological

examination

remains

the

reference

standard

for

deﬁnitive

diagnosis.

Accordingly,

evaluating

DCE-MRI

against

histopathology

is

essential for determining its clinical utility. The present

study

aimed

to

determine

the

diagnostic

accuracy

of

DCE-MRI

for

diﬀerentiating

benign

and

malignant

breast lesions using histopathology as the gold standard.

METHODOLOGY

This

cross-sectional

diagnostic-accuracy

study

was

conducted

in

the

Department

of

Radiology

in

collaboration

with

the

Departments

of

Surgery

and

Pathology

at

DHQ

Hospital,

Gujranwala,

Pakistan,

from

November

2023

to

April

2024.

Approval

and

research

permission

were

obtained

from

the

Research

Evaluation

Unit

(REU),

College

of

Physicians

and

Surgeons

Pakistan

(CPSP),

under

Reference

No.

CPSP/REU/RAD-2019-093-2889

dated

5

November

2021. Written informed consent was obtained from all

http://doi.org/10.37762/jgmds.13-4.970

26

J Gandhara Med Dent Sci

October - December 2026

participants, and patient confidentiality was maintained

throughout the study. A total of 96 patients with breast

lesions were enrolled using non-probability consecutive

sampling.

Eligible

participants

were

patients

of

either

sex with clinically suspected breast lesions referred for

DCE-MRI

and

subsequently

undergoing

histopathological

examination

by

biopsy

or

surgical

excision.

Patients

with

contraindications

to

MRI,

including

metallic

implants,

pacemakers,

or

severe

claustrophobia,

were

excluded.

Patients

with

prior

breast surgery, chemotherapy, or radiotherapy, as well

as those with incomplete imaging or histopathological

records, were also excluded. Data

were recorded on a

structured

proforma,

including

age,

marital

status,

family

history

of

breast

cancer,

presenting

symptoms,

side

and

location

of

the

lesion,

and

lesion

size.

All

participants

underwent

DCE-MRI

before

histopathological

assessment.

MRI

variables

included

lesion

margins,

enhancement

pattern,

BI-RADS

category,

and

overall

MRI

diagnosis

(benign

or

malignant).

Histopathology

was

considered

the

reference standard. MRI examinations were interpreted

by qualiﬁed radiologists according to standardized BI-

RADS

criteria.

Histopathological

assessment

was

performed by qualiﬁed pathologists who were reported

to be unaware of the MRI diagnosis, thereby reducing

observer

bias.

Data

were

analyzed

using

IBM

SPSS

Statistics

version

26.

Quantitative

variables

are

presented as mean ± standard deviation and categorical

variables

as

frequencies

and

percentages.

Diagnostic

performance was assessed using sensitivity, speciﬁcity,

positive

predictive

value

(PPV),

negative

predictive

value

(NPV),

and

overall

accuracy.

The

association

between

MRI

diagnosis

and

histopathology

was

assessed using the chi-square test, and Cramer's V was

calculated as an eﬀect-size measure. A p-value < 0.05

was considered statistically signiﬁcant.

RESULTS

A total of 96 patients with breast lesions were included.

The

mean

age

was

45.52

±

12.73

years

(range

22-65

years);

38.5%

were

older

than

50

years.

Most

participants

were

married

(75.0%),

and

18.8%

had

a

family history of breast cancer. A palpable breast lump

was

the

most

common

presenting

symptom

(41.7%).

Right-sided

lesions

accounted

for

59.4%,

and

lesions

measuring

2-5

cm

were

the

largest

size

Category

n (%age)

MRI margin

Smooth

35 (36.5)

Irregular

37 (38.5)

Spiculated

24 (25.0)

Enhancement pattern

Homogeneous

27 (28.1)

Heterogeneous

33 (34.4)

Rim enhancement

36 (37.5)

BI-RADS category

03

33 (34.4)

04

32 (33.3)

05

31 (32.3)

MRI diagnosis

Benign

40 (41.7)

Malignant

56 (58.3)

Histopathology

classiﬁed

54/96

(56.3%)

lesions

as

malignant and 42/96 (43.8%) as benign.

Diagnostic Accuracy of Dynamic Contrast-Enhanced Mri for Breast Lesions

27

J Gandhara Med Dent Sci

October - December 2026

Table 3: Histopathological Diagnosis of Breast Lesions (n = 96)

Histopathological Diagnosis

n (%age)

Benign

42 (43.8)

Malignant

54 (56.3)

Total

96 (100)

MRI

diagnosis

was

strongly

associated

with

histopathological

diagnosis

(

χ

²

=

53.33,

p

<

0.001;

Cramer's V = 0.745). DCE-MRI correctly identiﬁed 49

of 54 malignant lesions and 35 of 42 benign lesions.

Table

4:

Comparison

of

DCE-MRI

Diagnosis

with

Histopathology (n = 96)

MRI

Result

Histopathology

Benign n (%)

Histopathology

Malignant n

(%)

To

tal

χ

²

Crame

r's V

Benign

35 (36.5)

5 (5.2)

40

53.3

3

<0.001

0.745

Malignant

07 (7.3)

49 (51.0)

56

Total

42 (43.8)

54 (56.3)

96

Using

histopathology

as

the

reference

standard,

DCE-

MRI

achieved

a

sensitivity

of

90.7%,

speciﬁcity

of

83.3%,

PPV

of

87.5%,

NPV

of

87.5%,

and

overall

diagnostic accuracy of 87.5%.

Table

5:

Diagnostic

Accuracy

of

Dynamic

Contrast-Enhanced

MRI

Parameter

value

Sensitivity

90.7%

Specificity

83.3%

Positive Predictive Value (PPV)

87.5%

Negative Predictive Value (NPV)

87.5%

Overall Diagnostic Accuracy

87.5%

DISCUSSION

The present study evaluated the diagnostic accuracy of

dynamic

contrast-enhanced

magnetic

resonance

imaging

(DCE-MRI)

in

diﬀerentiating

benign

and

malignant

breast

lesions

using

histopathology

as

the

gold standard. The ﬁndings demonstrated that dynamic

MRI has high diagnostic performance, with sensitivity

of 90.7%, speciﬁcity of 83.3%, and overall diagnostic

accuracy of 87.5%. These results indicate that dynamic

MRI

is

a

reliable

imaging

modality

for

evaluating

breast lesions and support its increasing role in breast

imaging

practice.

In

the

current

research,

the

average

age

of

the

participants

was

45.52 ±

12.73

years,

with

most of the patients aged over 50 years. The incidence

of

breast

cancer

is

age-dependent,

and

the

same

demographic

patterns

were

evident

in

other

imaging

studies conducted on the assessment of breast lesions.

Advanced

imaging

modalities

are

thus

necessary

to

detect

the

problem

early

so

as

to

enhance

patient

outcomes.

The

clinical

presentation

observed

during

this research was that a palpable lump in the breast was

the most prevalent symptom of patients with lesions in

the

breast.

This

fact

conﬁrms

the

earlier

studies

that

show breast lumps as the commonest primary clinical

presentation

of

breast

malignancy,

which

may

necessitate

further

diagnostic

radiology

and

histopathological studies. In the present study, dynamic

MRI

revealed

that

anomalous

margins

and

rim

enlargement

occurred

commonly

with

suspicious

lesions. These are the imaging features that have been

extensively

reported

to

be

normal

MRI

features

of

malignant

breast

lesions.

It

has

been

shown

that

morphological

features

like

irregularity

of

the

margin

and

contrast

enhancement

patterns

have

a

signiﬁcant

role

to

play

in

the

diﬀerentiation

between

malignant

and benign lesions on MRI. Time-intensity curves and

enhancement patterns made available by imaging based

on

DCE-MRI

have

proven

to

give

useful

diagnostic

information

distinguishing

between

malignant

and

benign

breast

lesions.

12

In

the

current

research,

histopathology analysis established that 56.3 percent of

lesions

were

malignant.

This

observation

shows

that

precise

imaging

modalities

are

signiﬁcant

in

the

detection

of

suspicious

lesions

that

need

biopsy

or

surgical intervention. Histopathology has been the gold

standard

to

validate

the

diagnosis

of

breast

cancer,

although

imaging

methods

(e.g.

MRI)

aid

in

making

clinical decisions and minimizing unnecessary invasive

procedures. The diagnostic performance of the current

study

is

similar

to

that

published

in

several

recent

systematic reviews and meta-analyses. A meta-analysis

assessing the diagnostic validity of DCE-MRI showed a

pooled sensitivity of about 80% and speciﬁcity of about

84%

in

the detection

of

malignant

breast lesions,

and

this implies good diagnostic capability.

13

Likewise, the

results of a recent study assessing the categorization of

benign

and

malignant

breast

lesions

stated

that

MRI

exhibits a sensitivity rate of approximately 90-92% and

a

speciﬁcity

value

of

about

72-75%

in

the

diagnostic

power

of

MRI

in

breast

imaging.

14

The

results

are

similar to the current study, where sensitivity was over

90%. Another systematic review of studies comparing

contrast-enhanced

mammography

versus

breast

MRI

showed

that

a

pooled

MRI

sensitivity

of

around

97%

was

found

with

equal

levels

of

speciﬁcity,

again

indicating the high diagnostic potential of MRI in breast

cancer.

15

There

is

also

evidence

of

advanced

MRI

techniques

to

enhance

the

accuracy

of

diagnosis.

The

diﬀusion-weighted imaging (DWI) and multiparametric

MRI methods have also yielded encouraging outcomes

in the distinction of benign and malignant lesions of the

breast.

A

more

recent

meta-analysis

had

sensitivity

pooled

at

92%

and

speciﬁcity

at

88%

in

cases

of

diﬀusion-weighted

MRI

in

the

evaluation

of

breast

lesions.

16

The recent advances in ultrafast dynamic MRI

have

also

enhanced

characterization

of

lesions.

Researchers

have

proven

that

ultrafast

dynamic

contrast-enhanced MRI is able to eﬀectively distinguish

Diagnostic Accuracy of Dynamic Contrast-Enhanced Mri for Breast Lesions

p-valu

e

28

J Gandhara Med Dent Sci

October - December 2026

between benign and malignant breast lesions with less

scanning

time.

17

Moreover,

recent

studies

have

demonstrated that dynamic contrast-enhanced MRI plus

diﬀusion-weighted imaging is the most diagnostic of all

MRI procedures, with better speciﬁcity and fewer false-

positive

results.

18,19,20

The

statistically

signiﬁcant

association

observed

in

this

study

between

MRI

findings and histopathological diagnosis (

χ

² = 53.33, p

<

0.001)

further

conﬁrms

the

strong

relationship

between

MRI

imaging

characteristics

and

ﬁnal

pathological

outcomes.

The

calculated

Cramer's

V

value

of

0.745

indicates

a

strong

eﬀect

size

and

highlights the reliability of MRI as a diagnostic tool for

breast lesion evaluation. The negative predictive value

and the positive predictive value in this study were both

87.5%,

and

this

means

that

MRI

is

eﬀective

in

detecting

malignant

lesions

as

well

as

in

ruling

out

benign

lesions.

This

diagnostic

ability

is

especially

required

in

the

clinical

environment

where

early

and

precise

diagnosis

of

breast

cancer

has

a

major

impact

on

treatment.

Overall,

the

results

of

the

current

study

are in line with the increasing literature that has shown

that dynamic contrast-enhanced MRI is among the most

sensitive imaging techniques in the detection of breast

cancer

and

diﬀerentiation

of

malignant

versus

benign

tumors.

MRI

can

give

morphological

and

functional

data

of

the

breast

tissue,

and

this

can

enhance

characterization

of

lesions

and

aid

in

making

clinical

decisions.

LIMITATIONS

This

was

a

single-center

study

with

a

modest

sample

size,

which

may

limit

generalizability.

Diagnostic

performance

may

also

vary

across

scanners,

imaging

protocols,

reader

experience,

and

patient

populations.

Larger

multicenter

studies

using

standardized

DCE-

MRI protocols are recommended.

CONCLUSIONS

Dynamic

contrast-enhanced

MRI

demonstrated

high

sensitivity,

good

speciﬁcity,

and

strong

overall

diagnostic

accuracy

for

diﬀerentiating

benign

and

malignant

breast

lesions

when

compared

with

histopathology.

DCE-MRI

may

therefore

serve

as

a

valuable adjunct in the evaluation of suspicious breast

lesions,

particularly

when

conventional

imaging

is

inconclusive.

CONFLICT OF INTEREST:

None

FUNDING SOURCES:

None

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Mian Waheed Ahmad

-

Concept & Design; Data Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Maemoona

Tahira-

Concept & Design; Data Acquisition; Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Muqaddas

Fatima

-

Concept

&

Design;

Data

Acquisition;

Drafting

Manuscript;

Critical

Revision;

Supervision;

Final

Approval

Maryam

Anayatullah

-

Concept & Design; Data Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Zahid

Raheem

Shah

-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Areeba

Rashid

-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision;

Supervision;

Final

Approval

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Diagnostic Accuracy of Dynamic Contrast-Enhanced Mri for Breast Lesions