Multidetector Computed Tomography with Dedicated Protocol for Breast Cancer Locoregional Staging: Feasibility Study

Abstract

Background: The aim of this study was to demonstrate the feasibility of performing multidetector computed tomography (MDCT) with a dedicated protocol for locoregional staging in breast cancer patients. Methods: This prospective single-center study included newly diagnosed breast cancer patients submitted to contrast-enhanced chest MDCT and breast magnetic resonance imaging (MRI). MDCT was performed in prone position and using subtraction techniques. Fleiss’ Kappa coefficient (K) and intraclass correlation coefficient (ICC) were used to assess agreement between MRI, MDCT, and pathology, when available. Results: Thirty-three patients were included (mean age: 47 years). Breast MRI and MDCT showed at least substantial agreement for evaluation of tumor extension (k = 0.674), presence of multifocality (k = 0.669), multicentricity (k = 0.857), nipple invasion (k = 1.000), skin invasion (k = 0.872), and suspicious level I axillary lymph nodes (k = 0.613). MDCT showed higher number of suspicious axillary lymph nodes than MRI, especially on levels II and III. Both methods had similar correlation with tumor size (MRI ICC: 0.807; p = 0.008 vs. MDCT ICC: 0.750; p = 0.020) and T staging (k = 0.699) on pathology. Conclusions: MDCT with dedicated breast protocol is feasible and showed substantial agreement with MRI features in stage II or III breast cancer patients. This method could potentially allow one-step locoregional and systemic staging, reducing costs and improving logistics for these patients.

Iodinated Contrast Enhancement of Breast Cancer on Prone Multidetector Computed Tomography—Preliminary Findings

“…Several techniques can be used to improve breast evaluation on MDCT. As previously observed on PET-CT studies, prone position provides better characterization of breast lesions and allows direct comparison to breast MRI 23,28,29 . The use maximum intensity projection images in multiplanar projections also facilitates detection of breast lesions on chest CT 30 .…”

“…As previously observed on PET-CT studies, prone position provides better characterization of breast lesions and allows direct comparison to breast MRI. 23,28,29 The use maximum intensity projection images in multiplanar projections also facilitates detection of breast lesions on chest CT. 30 Precontrast images are important to avoid false-positive results related to spontaneously hyperdense lesions, especially hematomas in patients submitted to prior biopsy, which can mimic breast cancer. 31,32 Subtracted images can help to identify enhancing masses, however they are not usually necessary in our experience.…”

“…[15][16][17][18][19][20][21][22] Recently, prone MDCT with dedicated breast protocol has been shown to be feasible and showed substantial agreement with MRI features in breast cancer patients. 23 Nonetheless, further studies are necessary to better characterize the behavior of breast cancer on MDCT. The aim of this study was to assess breast cancer enhancement after iodinated contrast administration on prone MDCT.…”

“…Recently, prone MDCT with dedicated breast protocol has been shown to be feasible and showed substantial agreement with MRI features in breast cancer patients 23 . Nonetheless, further studies are necessary to better characterize the behavior of breast cancer on MDCT.…”

Diagnostic Accuracy of Contrast-Enhanced Thoracic Photon-Counting Computed Tomography for Opportunistic Locoregional Staging of Breast Cancer Compared With Digital Mammography

“…8 In clinical settings, patients with newly diagnosed breast cancer often undergo additional CT imaging of the complete thorax to determine the metastatic extent of the disease. 3,9 Breast cancer is associated with a strong uptake of intravascular contrast agents, 10 which has already been described for thoracic energy integrating detector CT. [11][12][13][14][15][16] Iodinated contrast agents have also been used in dedicated cone-beam breast CT 17,18 and dedicated photon-counting breast CT scanners 19 with promising results, showing an improved lesion conspicuity compared with examinations without contrast. 17 The potentially increasing availability of whole-body photoncounting computed tomography (PC-CT) scanners in the future 20 could present an opportunity to apply contrast-enhanced thoracic PC-CT technology (high spatial resolution, depiction of contrast uptake) in breast imaging without the need for additional breast-dedicated imaging devices.…”