Purpose: to study the possibilities of contrast enhanced dual-energy spectral mammography (CESM) in the diagnostics of malignant tumors in the breast.Material and methods. Forty-seven patients with suspicious for breast cancer (BC) lesions underwent CESM. Digital mammography (MMG) and post-contrast images were correlated with the results of path morphological studies after surgery or puncture biopsy was performed.Results. Sensitivity, specificity and overall accuracy in the diagnostics of breast cancer were 83.3%, 85.7%, 85.1% for digital mammography and 91.6%, 91.4%, 91.4% for CESM, respectively. The positive predictive value was 66.6% for digital MMG and 78.5% for CESM. The negative predictive value (NPV) was 96.9% for the CESM and exceeded NPV of the digital MMG, which was 93.7%.Conclusion. Thus, these findings suggest that CESM is an effective method for the diagnostics of malignant tumors in the breast.

Ранее представленная система Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) была разработана на основе консенсуса, достигнутого по результатам опубликованных исследований, содержащих экспертные и аналитические заключения. Многочисленные исследования, посвященные PI-RADS v2, не только подтвердили значимость унифицированной системы в диагностике рака предстательной железы, но и выявили ряд ее недостатков. В целях устранения недостатков, допущенных в системе PI-RADS v2, были предложены некоторые нововведения. Руководящий комитет PI-RADS рекомендовал внести изменения в PI-RADS v2, сохранив при этом структуру в виде определения числа баллов для отдельных методик и использования этих баллов для получения итоговой категории. Обновленная версия была опубликована как PI-RADS v2.1 в начале 2019 г. Ожидается, что использование PI-RADS v2.1 оптимизирует, упростит оценку результатов магнитно-резонансной томографии предстательной железы и уменьшит количество ошибок интерпретации. При этом планируется продолжить дальнейшие исследования, посвященные оценке клинической значимости данной системы при выборе лечебной стратегии и наблюдении за пациентами с высоким потенциалом развития клинически значимого рака предстательной железы.

М а м м о л о г и я / M a m m o l o g y 4 ' 2 0 1 9

Dual-energy contrast-enhanced spectral mammography (CESM) is a new promising method for visualizing pathological changes in breast, which combines digital mammography and a functional assessment of vascularization using intravenous contrast ehnancement. According to accumulated experience CESM is well tolerated by patients and is similar to magnetic resonance imaging with dynamic contrast enhancement (MRI with DCE), but at the same time, CESM is more affordable and can be performed in patients with contraindications for MRI. However, few studies have been conducted to evaluate the role of CESM. In the world literature, interpretation of contrast images is based only on the degree of accumulation of the contrast agent, but we propose a more detailed assessment of the structure of the hypervascular lesions by highlighting the contrast enhancement patterns. Objective: to determine the diagnostic effectiveness of CESM using the contrast enhancement patterns in malignant and benign lesions. Materials and methods. 239 women with suspicious for breast cancer lesions were examined from August 2018 to December 2019. The mean age of the women was 51 years. 322 lesions were revealed, 149 (46.3%) were malignant, 173 (53.7%) were benign. All lesions were histologically confirmed. As a result of the analysis of our data, 9 types of contrast enhancement patterns were distinguished: reticulate, granular, annular, diffuse-spherical, lacunar, cloud-like, heterogeneous-annular, point, cotton-like. Results. Using an additional diagnostic feature - contrast enhancement patterns in lesions, increased the sensitivity of CESM from 91.3% to 98.0% (p=0.26), specificity from 80.3% to 93, 6% (p=0.013), accuracy from 85.4 to 95.7% (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, this approach of interpreting subtraction images allows to increase the efficiency of CESM in diagnosis of breast cancer.

Background. Breast cancer (BC) can be unifocal, multifocal, multicentric (MCBC) and bilateral according to number and localization of tumors. MCBC has different clinical and biological characteristics compared to unifocal BC, for example, a higher risk of lymph node involvement, a more aggressive natural history and a worse prognosis. Therefore, accurate diagnosis and detection of MCBC is one of the main tasks of imaging.Objective: to compare diagnostic accuracy of contrast enhanced spectral mammography (CESM) and digital mammography (DM) in the diagnosis of MCBC.Materials and methods. The study included 438 women with suspected BC. The results of DM and CESM were compared with the results of a pathomorphological study performed after surgery or biopsy to assess the effectiveness of imaging modalities. DM was performed for all women using a Senographe DS (GE, USA) unit. CESM was performed after intravenous injection of non-ionic contrast agents using injector with breast compression in the craniocaudal and mediolateral projections. The study was performed for both glands regardless of the location of the suspicious lesion in order to timely diagnose clinically asymptomatic bilateral cancer. The final diagnosis was made based on the results of the pathomorphological examination. MCBC was diagnosed when two or more tumors at a distance of 3 cm or more from each other were detected. Visualization of additional grouped calcifications of malignant type occupying a small portion of breast tissue (more than 15 pieces per 1 sq. cm) was considered as another mammographic sign of MCBC.Results. According to the pathomorphological examination BC was diagnosed in 154 (35 %) women out of 438 examined patients. MCBC was identified in 25 (16 %) of 154 patients. CESM was more effective than DM in detecting MCBC with sensitivity of 88.0 % vs 48.0 % (p = 0.002), accuracy of 92.2 % vs 90.9 %, negative predictive value of 97.6 % vs 90.8 % (p = 0.02), respectively. But the specificity was significantly higher in DM than in CESM – 99.2 % vs 93.0 % (p = 0.009), respectively, and the positive predictive value did not differ significantly (p = 0.12).Conclusion. CESM is a more sensitive method for diagnosing MCBC compared to DM with sensitivity of 88.0 % vs 48.0 %. The high negative predictive value of CESM (97.6 %) confirms the fact that this modality is an effective method for planning surgery and radiation therapy.