Correlation between quantitative assessment of contrast enhancement in contrast-enhanced spectral mammography (CESM) and histopathology—preliminary results

Abstract

ObjectivesContrast-enhanced spectral mammography (CESM) is a novel method for breast cancer detection. The aim of this study is to check if there is a possibility of quantitative assessment of contrast enhancement in CESM and if there is any correlation between quantitative assessment of contrast enhancement in CESM and histopathology.MethodsA total of 167 female patients underwent CESM. All subjects previously had suspicious lesions found on mammography, breast ultrasound, or both. After imaging, the following parameters were evaluated: number of enhancing lesions in each breast and size and degree of enhancement of each lesion. Based on the collected data, the percentage signal difference between enhancing lesion and background (%RS) and signal-difference-to-noise ratio (SDNR) were measured for each lesion.ResultsThe number of lesions detected in the study population was 195. Among all diagnosed lesions, 120 (62%) were assessed to be infiltrating cancers, 16 (8%) non-infiltrating cancers, and 59 (30%) were benign. Thirteen (7%) lesions did not enhance in CESM; all non-enhancing lesions were confirmed to be benign under histopathological examination. Analysis of enhancement indices showed that signal values within lesions and signal values within background ROIs (regions of interest) were similar in CC (craniocaudal) and MLO (mediolateral) projections. Mean %RS values were correlated with the type of enhancing lesion, infiltrating cancers having the highest values, benign lesions the lowest.ConclusionsThis work has demonstrated a significant correlation between the degree of lesion enhancement in CESM and malignancy. Quantitative analysis of enhancement levels in CESM can distinguish between invasive cancers and benign or in situ lesions.Key Points • There is a possibility of quantitative assessment of contrast enhancement in CESM. • Correlation between quantitative assessment of contrast enhancement in CESM and histopathology was observed.

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

“…For enhancement intensity, this preliminary research suggested that enhancement intensity of malignancies was usually stronger than that of benign lesions (Table 1), which was consistent with other researchers' findings 6,[11][12][13][14]17 . Lewin et al 6 concluded that 84.6% (11/13) of invasive cancers enhanced strongly, while all benign lesions (n = 12) were presented as no or weak enhancement qualitatively.…”

“…Rudnicki et al 12 and our researches took a quantitative method to evaluate enhancement intensity of lesions on the both two projections (CC and MLO views). Rudnicki et al adopted the percentage signal difference between enhancing lesion and background (%RS) to value the intensity of lesions, which was similar to CNR index in this research.…”

“…So far, the order of image acquisition (CC prior to MLO or MLO prior to CC) on CESM was controversial 21 . In published papers, some exposed MLO views first 11,16,22 , while others performed CC views first 12,13 . In our CESM protocols, the sequence of CC or MLO position was not fixed.…”

“…Given that a number of benign lesions can reveal enhancement on CESM 8,11 , researchers have focused on how to differentiate breast cancers from benign lesions and improve the diagnostic specificity. Previous studies [12][13][14] have proved the diagnostic performance of enhancement intensity for breast cancers and concluded that enhancement intensity of malignancies was usually stronger than that of benign lesions. Moreover, invasive cancers were inclined to enhance stronger than non-invasive cancers and benign lesions 12,14 .…”

“…Previous studies [12][13][14] have proved the diagnostic performance of enhancement intensity for breast cancers and concluded that enhancement intensity of malignancies was usually stronger than that of benign lesions. Moreover, invasive cancers were inclined to enhance stronger than non-invasive cancers and benign lesions 12,14 . However, there is no research before investigating the correlation between enhancement intensity and hormonal receptor status of breast cancers.…”