role of contrast enhanced spectral mammography in assessment of focal breast asymmetry

Abstract

Background: Contrast enhanced mammography (CESM) is one of the relatively novel imaging modalities. Many studies have suggested that CESM is superior to mammography in the identification of multiplicity, extent and size of malignant lesions especially in the dense breast parenchyma Aim: Characterization of focal breast asymmetry by using intravenous contrast material with full-field digital mammography. Methods: This study included 60 female patients who presented for screening and diagnostic mammogram at mammography unit in Egyptian National Cancer Institute. All enrolled cases had focal breast asymmetries detected on mammogram. Ultrasound examination and CESM using dual-energy acquisitions were performed for all included patients. Histopathology after ultrasound guided true cut biopsy was the standard reference for detecting lesions Results: Regarding overall validity of CESM, it was found that CESM had sensitivity 92.85%, specificity 88.9%. PVP and PVN were 95.1% and 84.42% respectively with accuracy 91.66%. CESM sensitivity increased to 93.9% in detection of mass enhanced lesions with accuracy 92.5%. In non-mass enhanced CESM sensitivity decreased to 88.9% with accuracy 90% while its specificity was 90.9%. In mass enhanced lesions shape of the mass had the highest sensitivity 90.0% and specificity 85.7% with accuracy 90.0%. In nonmass lesions pattern of enhancement had the highest sensitivity 88.9%. Conclusion: CESM is valid and reliable tool in assessment of focal asymmetries. Enhancement and morphology characteristics are valuable in differentiation of benign and malignant breast lesions.