Diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM): a retrospective study involving 644 breast lesions

Background: Dual-energy contrast-enhanced spectral mammography (CESM) is one of the latest methods for breast lesions characterization, where structural and functional (i.e., vascularization) assessment are combined. Nowadays an interpretation of contrast-enhanced images is based only on the degree of contrast enhancement, but we propose a more detailed assessment of the structure of the hypervascular lesions by highlighting the contrast enhancement patterns. Purpose: To evaluate the diagnostic performance of contrast-enhanced spectral mammography (CESM) using the contrast enhancement patterns in malignant and benign lesions. Material and Methods: Study included 332 women examined from February 2018 to June 2020. The mean age of the women was 50 years. Of 428 lesions totally revealed, 172 (40.2%) were histologically verified as malignant and 256 (59.8%) as benign. We proposed 9 types of contrast enhancement patterns to describe lesions: reticular, granular, annular, diffuse-spherical, lacunar, cloud-like, heterogeneous-annular, point, cotton-like. Results: We showed that diagnostic performance of CESM increased sensitivity if an additional diagnostic feature of contrast enhancement pattern was used: sensitivity increased from 79.7% to 94.8% (p = 0.26), specificity from 82.4% to 95.3% (p = 0.013) and accuracy from 81.3 to 95.1% (p = 0.004), in comparison with using of only one feature of contrast enhancement intensity in the differential diagnosis of malignant and benign lesions. Conclusion: Thus, using contrast enhancement pattern allows to increase the efficiency of CESM in breast cancer detection.

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The Value of Contrast Enhanced Spectral Mammography in BIRADS Categorization of Equivocal and Suspicious Breast Lesions

QJM ◽

10.1093/qjmed/hcaa068.017 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S B Ali ◽

M E Elshinawi ◽

N A Chalabi ◽

N N H Keriakos ◽

W A M H Attia

Keyword(s):

Diagnostic Performance ◽

Final Diagnosis ◽

Breast Lesions ◽

Female Patients ◽

Contrast Enhanced ◽

Conventional Mammography

Abstract Aim To evaluate the capability of CESM to upgrade/downgrade BIRADS category of equivocal and suspicious breast lesions. Patients and Methods Thirty female patients with 44 equivocal and suspicious breast lesions, were enrolled in our study, age ranged from 20 to 76 years. All patients underwent conventional mammography and ultrasound then CESM. Results Mammography+Ultrasound categorized 40/44 lesions (90.9%) lesions to be malignant (BIRADS 4,5) and 4/44 lesions (9.1%) to be benign (BIRADS1,3). CESM categorized 35/44 lesions (79.5% )to be malignant (BIRADS 4,5) and 9/44 lesions (20.5% ) to be benign (BIRADS1,3). Disagreement about BIRADS category was observed in 25% of the examined lesions including upgraded and down graded lesions in 11.36 % and 13.6 % respectively. 100% of up/down graded lesions also proved CESM to be correct in reference to the final diagnosis. Conclusion CESM has better diagnostic performance than mammography plus Ultrasound and provides a valuable tool to accurately evaluate equivocal and suspicious breast lesions.

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