Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

Abstract

To compare diagnostic performance of contrast-enhanced dual-energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast-enhanced MRI (DCE-MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3-5 at imaging or clinically suspicious). CEDM, DBT, and DCE-MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two-dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE-MRI. DCE-MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE-MRI and CEDM (P = .03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE-MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE-MRI. Dynamic information obtained by time-intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions. | 861 PETRILLO ET aL.

Which clinical, radiological, histological, and molecular parameters are associated with the absence of enhancement of known breast cancers with Contrast Enhanced Digital Mammography (CEDM)?

“…Unlike reports in previous studies on both on MRI and CEDMs, in our study the BPE level did not show significant correlation with the TFN results and it cannot be considered an important factor that obscured abnormal enhancing lesions [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [21] , [22] , [23] , 32 ]. In our study this result is probably due to the very limited number of cases with a marked BPE level, only 17 cases compared to 131 with the minimal, 126 with the mild and 56 with the moderate level.…”

“…Contrast Enhanced Digital Mammography (CEDM) is the most recent diagnostic breast imaging technique that has already demonstrated a sensitivity for detecting breast cancer (BC) which is higher than digital mammography (DM) and similar to that of contrast-enhanced MRI [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] ]. One of the indications of CEDM is the preoperative staging of patients with a recent diagnosis of BC, and also in this context it has demonstrated a high sensitivity (88%–100%) and specificity (82%–98%) with a diagnostic performance similar to MRI and superior to conventional imaging like DM, ultrasound (US), digital breast tomosynthesis (DBT) [ [9] , [10] , [11] , [12] , [13] , [14] ].…”

“…From the analysis of several studies published in literature that evaluate the diagnostic performance of CEDM in various subgroups of patients for different purposes, an FN rate emerged between 0% and 20%. Lack of enhancement has been reported for tumors of very different sizes and for all BC types, including both invasive carcinomas and DCIS [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , 32 ].…”

The Diagnostic Value of Contrast-enhanced 2D Mammography in Everyday Clinical use

“…These studies were also relatively small, with sample sizes varying from 34 to 100 patients, with two exceptions up to 208 and 326 patients. One study provided a case-by-case description of the performance of CEM [23] , but in the other ten studies, sensitivity of CEM ranged from 81.5-100% [16,17,[20][21][22][23][24][25][26][27], with speci city available in just three studies and ranging from 42.6-79.6% [24]-[26] . However, the differences in methodologies used in these studies hamper a robust comparison of our results with these eleven studies.…”

Introduction to Special Issue of Radiology and Imaging of Cancer

“…Medical imaging comprises a huge number of imaging techniques, and multiple biomedical imaging techniques are used in all phases of cancer management because they are able to provide morphological and functional data [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. In addition, image-guided invasive therapy has the promise to improve outcomes and reduce collateral effects compared to systemic or surgical treatment [ 20 , 21 ].…”