Added value of contrast-enhanced mammography in assessment of breast asymmetries

Abstract

Objective: To evaluate the clinical performance of contrast-enhanced spectral mammography (CESM) on asymmetries detected on a mammogram (MG). Methods: This study was approved by the Scientific Research Review Board of the Radiology Department, and waiver of informed consent was applied for the uses of data of the included cases. The study included 125 female patients,33 (26.4%) who presented for screening and 92 (73.6%) who presented for a diagnostic MG. All had breast asymmetries on MG. Ultrasound examination and CESM using dual-energy acquisitions were performed for all patients. Results: In all, 88/125 (70.4%) females had focal asymmetry (seen in two views and occupying less than a quadrant), 26/125 (20.8%) had global asymmetry (occupying more than one quadrant), 10/125 (8%) had asymmetry (seen in a single view and occupying less than a quadrant), and 1/125 had developing asymmetry (0.8%) (not present in the previous MG). Malignant lesions represented 91 cases, benign lesions represented 30 cases, and 4 cases were high-risk lesions. CESM sensitivity was 100% (v s 97.8 % for sono-mammography), specificity was 55.88% (v s 81.8% for sono-mammography), and the positive- and negative-predictive values were 85.85 and 100% (v s 93.7 and 93% for sono-mammography respectively) . Conclusion: In our study, we conclude that focal and global asymmetries with other suspicious mammographic findings were statistically significant for malignancy and CESM played an important role in delineating tumor size and extension. Any non-enhancing asymmetrical density correlated with a benign pathology, if not associated with other suspicious imaging findings. Advances in knowledge: Our study is the first to explore the added value of CESM to asymmetries detected in screening and diagnostic mammography.

Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography

“…Based on the angiogenesis, breast lesions can be clearly demonstrated on CESM by eliminating the overlapping of breast fibroglandular tissues [4][5][6] . CESM is superior to conventional mammography and improves breast cancer detection 10 .…”

“…LE images are similar to full-field digital mammography (FFDM) 3 , which can clearly demonstrate the morphological features of breast lesions. On the basis of angiogenesis, breast lesions reveal enhancement and are highlighted on subtraction images by eliminating overlapping of breast fibroglandular tissues [4][5][6] . Accordingly, CESM dramatically improves the cancer detection and decreases the misdiagnosis rate, especially in dense breasts [7][8][9][10] .…”

Diagnostic accuracy of contrast-enhanced digital mammography in comparison with sonomammography for characterization of focal asymmetries

“…Our results showed a positive moderate correlation between lesions in CEDM and pathology (0.6) as majority of malignant pathology was detected as mass enhancement particularly and benign pathology and normality in non- enhanced lesions. A recent study documented a significant correlation between asymmetry showing "mass or non-mass enhancement" and malignancy and between non-enhancing findings and benign pathology [8]. CEDM has the potential to depict angiogenesis, which is more pronounced in IDC [13,14].…”

“…The study aimed to evaluate diagnostic accuracy of CEDM for characterization of focal asymmetries in 2D mammography. Few studies evaluated this topic and most of them have investigated asymmetry in general [3,7,8]. However, this study focused exclusively on focal asymmetry.…”

“…There are many reports investigating the value of CEDM in the assessment of breast lesions [3,6,7]. However, few papers assessed its value in cases of mammographic focal asymmetry in particular to verify the pathological nature of those lesions [8].…”