Workflow Considerations for Incorporation of Contrast-Enhanced Spectral Mammography Into a Breast Imaging Practice

Contrast-enhanced spectral mammography (CESM) is a promising, digital breast imaging method for planning surgeries. The study aimed at comparing digital mammography (MG) with CESM as predictive factors in visualizing multifocal-multicentric cancers (MFMCC) before determining the surgery extent. We analyzed 999 patients after breast cancer surgery to compare MG and CESM in terms of detecting MFMCC. Moreover, these procedures were assessed for their conformity with postoperative histopathology (HP), calculating their sensitivity and specificity. The question was which histopathological types of breast cancer were more frequently characterized by multifocality–multicentrality in comparable techniques as regards the general number of HP-identified cancers. The analysis involved the frequency of post-CESM changes in the extent of planned surgeries. In the present study, MG revealed 48 (4.80%) while CESM 170 (17.02%) MFMCC lesions, subsequently confirmed in HP. MG had MFMCC detecting sensitivity of 38.51%, specificity 99.01%, PPV (positive predictive value) 85.71%, and NPV (negative predictive value) 84.52%. The respective values for CESM were 87.63%, 94.90%, 80.57% and 96.95%. Moreover, no statistically significant differences were found between lobular and NST cancers (27.78% vs. 21.24%) regarding MFMCC. A treatment change was required by 20.00% of the patients from breast-conserving to mastectomy, upon visualizing MFMCC in CESM. In conclusion, mammography offers insufficient diagnostic sensitivity for detecting additional cancer foci. The high diagnostic sensitivity of CESM effectively assesses breast cancer multifocality/multicentrality and significantly changes the extent of planned surgeries. The multifocality/multicentrality concerned carcinoma, lobular and invasive carcinoma of no special type (NST) cancers with similar incidence rates, which requires further confirmation.

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Contrast-enhanced spectral mammography in patients with MRI contraindications

Acta Radiologica ◽

10.1177/0284185117735561 ◽

2017 ◽

Vol 59 (7) ◽

pp. 798-805 ◽

Cited By ~ 13

Author(s):

Vivien Richter ◽

Valerie Hatterman ◽

Heike Preibsch ◽

Sonja D Bahrs ◽

Markus Hahn ◽

...

Keyword(s):

Problem Solving ◽

Diagnostic Accuracy ◽

Breast Imaging ◽

Diagnostic Yield ◽

Therapy Response ◽

Lesion Size ◽

Size Estimation ◽

Imaging Data ◽

Technical Problems ◽

Contrast Enhanced

Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method’s technical limitations.

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The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria

British Journal of Radiology ◽

10.1259/bjr.20200880 ◽

2021 ◽

Vol 94 (1120) ◽

pp. 20200880

Author(s):

Fan Zhang ◽

Lifang Jin ◽

Gang Li ◽

Chao Jia ◽

Qiusheng Shi ◽

...

Keyword(s):

Diagnostic Criteria ◽

Sensitivity And Specificity ◽

Breast Imaging ◽

Diagnostic Value ◽

Binary Logistic Regression Analysis ◽

Lower Sensitivity ◽

Breast Lesions ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Histopathological Results

Objectives: To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria. Methods: A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared. Results: Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, p = 0.003), enhancement area (OR = 4.25, p = 0.005), and radial or penetrating vessels (OR = 7.54, p = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively. Conclusions: CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs. Advances in knowledge: In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.

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Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results

Tumori Journal ◽

10.1177/0300891618816212 ◽

2018 ◽

Vol 105 (5) ◽

pp. 378-387 ◽

Cited By ~ 5

Author(s):

Giulia Bicchierai ◽

Jacopo Nori ◽

Diego De Benedetto ◽

Cecilia Boeri ◽

Ermanno Vanzi ◽

...

Keyword(s):

Breast Imaging ◽

Surgical Excision ◽

Surgical Biopsy ◽

Predictive Values ◽

Contrast Enhanced ◽

B3 Lesions ◽

Malignant Lesions ◽

Sensitivity Specificity

PurposeTo evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB).MethodsThe local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41–77 years were included in our study. All patients underwent CESM 2–3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings.ResultsThe sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451–.696), for categorization of BPE from moderate to substantial (κ = .562–.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346–.459).ConclusionIn cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.

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Advanced Imaging Techniques for the Detection of Breast Cancer

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.223 ◽

2012 ◽

pp. 65-69 ◽

Cited By ~ 4

Author(s):

Maxine Jochelson

Keyword(s):

Breast Cancer ◽

High Risk ◽

Breast Imaging ◽

Early Stage ◽

Imaging Techniques ◽

Breast Cancer Mortality ◽

Digital Breast Tomosynthesis ◽

Ct Scanning ◽

High Risk Women ◽

Contrast Enhanced

Overview: Mammography is the only breast imaging examination that has been shown to reduce breast cancer mortality. Population-based sensitivity is 75% to 80%, but sensitivity in high-risk women with dense breasts is only in the range of 50%. Breast ultrasound and contrast-enhanced breast magnetic resonance imaging (MRI) have become additional standard modalities used in the diagnosis of breast cancer. In high-risk women, ultrasound is known to detect approximately four additional cancers per 1,000 women. MRI is exquisitely sensitive for the detection of breast cancer. In high-risk women, it finds an additional four to five cancers per 100 women. However, both ultrasound and MRI are also known to lead to a large number of additional benign biopsies and short-term follow-up examinations. Many new breast imaging tools have improved and are being developed to improve on our current ability to diagnose early-stage breast cancer. These can be divided into two groups. The first group is those that are advances in current techniques, which include digital breast tomosynthesis and contrast-enhanced mammography and ultrasound with elastography or microbubbles. The other group includes new breast imaging platforms such as breast computed tomography (CT) scanning and radionuclide breast imaging. These are exciting advances. However, in this era of cost and radiation containment, it is imperative to look at all of them objectively to see which will provide clinically relevant additional information.

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Does contrast-enhanced ultrasound (CEUS) play a better role in diagnosis of breast lesions with calcification? A comparison with MRI

British Journal of Radiology ◽

10.1259/bjr.20200195 ◽

2020 ◽

Vol 93 (1112) ◽

pp. 20200195

Author(s):

Jiamin Pan ◽

Wenjuan Tong ◽

Jia Luo ◽

Jinyu Liang ◽

Fushun Pan ◽

...

Keyword(s):

Breast Imaging ◽

Breast Lesions ◽

Diagnostic Efficiency ◽

Contrast Enhanced Ultrasound ◽

Roc Curve Analysis ◽

Diagnostic Efficacy ◽

Score System ◽

Contrast Enhanced ◽

Significant Difference

Objective: To compare the efficacy of contrast-enhanced ultrasound enabled reclassification of Breast Imaging Reporting and Data System (CEUS-BI-RADS) with MRI in the diagnosis of breast lesions with calcification. Methods: A total of 52 breast lesions with calcification from 51 patients were detected by ultrasound as hyperechoic foci and categorized as BI-RADS 3–5. The 51 patients further underwent CEUS scan and MRI. The ultrasound-BI-RADS combined with CEUS 5-point score system redefined the classification of BI-RADS which was called CEUS-BI-RADS. The diagnostic efficacy of three methods was assessed by receiver operating characteristic (ROC) curve analysis. Histopathological assessment used as the gold-standard. Results: The sensitivities of Ultrasound-BI-RADS, MRI classification of BI-RADS (MRI-BI-RADS) and CEUS-BI-RADS were 85%, 90% and 95% without significant difference among the three modalities (p > 0.05). The diagnostic specificities of ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS were 78.1%, 78.1% and 96.8%, respectively (p < 0.05); and the accuracy were 80.7%, 82.6% and 96.1% for ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS, respectively (p < 0.05). The area under ROC (AUROC) in differentiation of breast lesions with calcification was 0.945 for CEUS-BI-RADS, 0.907 for MRI-BI-RADS and 0.853 for ultrasound-BI-RADS, with no significant difference among the three modalities (p > 0.05). Conclusion: The CEUS-BI-RADS has a better diagnostic efficiency than MRI-BI-RADS in the differentiation of the breast lesions with calcification. Advances in knowledge: •CEUS is a better method in differentiation of breast lesions with calcification. •CEUS-BI-RADS increases the efficiency of diagnosis compared to MRI.

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