The Quality of Tumor Size Assessment by Contrast-Enhanced Spectral Mammography and the Benefit of Additional Breast MRI

Lobbes, Marc; Lalji, Ulrich; Nelemans, Patty J.; Houben, Ivo; Smidt, Marjolein L.; Heuts, E. M.; Vries, Bart de; Wildberger, Joachim E.; Beets-Tan, Regina

doi:10.7150/jca.10705

Cited by 101 publications

(71 citation statements)

References 19 publications

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“…The BI-RADS lexicon provides descriptors and assessment categories that can be used to predict the likelihood of malignancy for contrast-enhancing lesions on CE-MRI [18,19]. Recent studies have used MRI imaging characteristics for the evaluation of CEDEM images [9,10,13,14]; however, there is no data on the direct applicability of the MRI BI-RADS descriptors for contrastenhancing lesions on CEDEM.…”

Section: Introductionmentioning

confidence: 99%

“…When added to mammography, it has the potential to increase diagnostic accuracy [10,11] and can facilitate the visualization of breast lesions [11,12]. Accuracy, sensitivity, specificity, lesion detection rate, and assessment of tumor size are comparable to CE-MRI of the breast [13][14][15][16][17]. The BI-RADS lexicon provides descriptors and assessment categories that can be used to predict the likelihood of malignancy for contrast-enhancing lesions on CE-MRI [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Application of BI-RADS Descriptors in Contrast-Enhanced Dual-Energy Mammography: Comparison with MRI

et al. 2017

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Background: Contrast-enhanced (CE) magnetic resonance imaging (MRI) BI-RADS descriptors are used in the evaluation of contrast-enhanced dual-energy mammography (CEDEM) images of mass lesions and are assumed to be applicable. Patients and Methods: Patients with suspicious mass lesions on mammography (BI-RADS 4 or 5) were included. CEDEM examinations were performed using a modified prototype unit. CE-MRI was performed using a high temporal and high spatial resolution imaging protocol. 2 blinded breast radiologists evaluated all images using criteria related to contrast enhancement intensity and morphology according to the BI-RADS lexicon (5th edition) in 2 sessions. Histopathology was used as the standard of reference. Results: 11 patients with 5 benign and 6 malignant index lesions were included. Enhancement characteristics were similar in the malignant cases. Enhancement of the benign lesions was moderate on CEDEM and strong on MRI. Discrepancies in the BI-RADS descriptors did not influence the final BI-RADS score. Overall, the BI-RADS assessment was almost identical in all cases. 1 malignant lesion was rated BI-RADS 4 with CEDEM and BI-RADS 5 with MRI, and 1 benign was rated BI-RADS 2 and BI-RADS 1, respectively. Conclusion: MRI BI-RADS descriptors of contrast-enhancing lesions can be applied for the morphologic analysis of mass lesions on CEDEM.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of BI-RADS Descriptors in Contrast-Enhanced Dual-Energy Mammography: Comparison with MRI

et al. 2017

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“…CESM provides images which are more familiar to surgeons with the same breast proportions as FFDM. The last but not the least is frugal consideration as CESM provides the same range of information for the fraction of breast MRI cost [12][13][14].…”

Section: Dromain Et Al Confirmed That the Initial Clinical Results Showmentioning

confidence: 99%

Comparing Diagnostic Pathway of Two Patients Squamous Cell Carcinoma of the Breast-Favourable Diagnostic Input of CESM

Pascaline¹

2016

JCPCR

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A The vast majority of diagnosed squamous cell carcinomas (SCC) are located in the skin, few present within internal structures. Primary breast SCC is a rare unusual tumor, constituting less than 0.1% of all breast carcinomas [1]. Literature reviews mention just about 100 cases of breast SCC to date, but most of the cases are included in a variety of histologic patterns reviews in addition to SCC [2]. Clinical and radiologic appearances of breast SCC are not specific which may cause delays in the correct diagnosis of this rare but quite aggressive type of breast cancer. This article demonstrates two cases of breast SCC diagnosed in Kettering Breast Unit in the last five years and difference in their diagnostic pathway due to the utilisation of contrast enhanced mammography for the second patient. IntroductionThe diagnosis of primary SCC of the breast is made in the absence of an associated primary SCC in a second site and in the absence of skin involvement. Squamous cells are normally not found inside the breast, so a primary squamous cell carcinoma of the breast is an exceptional phenomenon. Reported here are two cases of primary breast SCC presenting initially as complex cysts. However, in the literature there are examples of different presentations, for example starting as an abscess [3]. Case 1A 67 years old lady presented with large, painfull lump in the right axillary tail which appeared suddenly after active prolonged gardening. The first ultrasound scan demonstrated a 6 cm cyst/ fluid collection which was suspected to have been caused by a possible rupture of the big pectoralis muscle. Axilla at the first presentation was unremarkable and blood was drained from suspected haematoma. The haematoma refilled after 7 days and forther aspirate was sent to cytology which demonstrated C5 abnormal cells with squamoid features. The patient was referred for repeat ultrasound and core biopsy. Before biopsy of the bizarre by now looking cystic structure (Figure 1) was again drained and the solid looking component of the walls biopsied. Histology reported features in keeping with poorly differentiated squamous cell carcinoma. A dark lymphnode biopsied at the same time proved to be metastatic.Chest CT with contrast demonstrated a large (8.7cm x 7.9cm x 6.4cm) mixed attenuation partly cystic partly solid mass is seen occupying most of the right axilla and demonstrates patchy enhancement. A couple of sub cm lymph nodes are seen in the vicinity (Figure 2 Cytology report statedThe appearance is unusual. If the cyst was truly in the breast and not in a subcutaneous position, the appearance may indicate squamous metaplasia/neoplasia in a cyst that has arisen in fibrocystic disease.Squamous lined cysts of the breast are rare but have been described.Per MDT decision patient was referred for contrast enhanced spectral mammography (CESM )The low energy image identical to conventional FFDM images (Figure 3) demonstrates a moderate/ low density round structure with partially obscured posterior margin.Figure 4 recombined h...

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“…In addition, the fact that CESM requires approximately a 1.5 times greater radiation dose than conventional mammography (8, 11) has been seen as a disadvantage. However, to date, the false negative and false positive rates of CESM have been reported to be very low (11), and recent studies have demonstrated that it could have a sensitivity and sensibility similar to that of MRI, while having the advantage of being faster, much more economical, and not presenting the aforementioned contraindications of MRI (4, 6, 7). As such, CESM is a very promising imaging diagnostic tool, which may be useful in the diagnosis of complex breast lesions, as illustrated by this presented case report.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, contrast-enhanced breast magnetic resonance imaging (MRI) currently appears as the most sensitive technique to detect and stage breast cancer (4, 5). However, several recent studies have shown that the emerging dual-energy, contrast-enhanced digital mammography (CESM) method enables accurate detection of malignant breast lesions with a similar performance to that of MRI (4, 6-8), making it a good alternative to this expensive technique.…”

Section: Introductionmentioning

confidence: 99%

A Case of a Concurrent and Co-Located Invasive Carcinoma and a Fibroadenoma to Illustrate the Potential of Dual-Energy, Contrast-Enhanced Digital Mammography on the Diagnosis of Complex Breast Lesions

Aja¹,

Muñoz²,

Rodríguez³

et al. 2016

Iran J Radiol

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Up to 19% of breast malignancies may be missed by conventional imaging techniques, especially when they are concurrent or co-located with other benign lesions. However, more sensitive techniques, such as magnetic resonance imaging (MRI), are often too expensive for routine use in developing countries. Contrast-enhanced, dual-energy digital mammography (CESM) is a recently introduced imaging modality whose performance has been reported to be similar to that of MRI. Being much cheaper, CESM may constitute a good alternative for improving diagnostic sensitivity in these countries. In this paper, we present a challenging case of the concurrent and co-located presentation of a fibroadenoma and a triple negative invasive carcinoma of no special type (TNBC-NST). The malignancy was indistinguishable from the fibroadenoma by mammography. By ultrasound, a suspicious area was observed and biopsied, but the histopathology did not confirm a cancer diagnosis. As the suspicion was not confirmed, a second stage of the imaging diagnosis using CESM was recommended. This technique allowed clear visualization of the malignancy, which was finally excised by breast-conserving surgery. This case reveals the potential of CESM as an easy, rapid and inexpensive new technique for the diagnosis of malignancies that might easily remain occult to mammography plus breast ultrasound (BUS).

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The Quality of Tumor Size Assessment by Contrast-Enhanced Spectral Mammography and the Benefit of Additional Breast MRI

Cited by 101 publications

References 19 publications

Application of BI-RADS Descriptors in Contrast-Enhanced Dual-Energy Mammography: Comparison with MRI

Application of BI-RADS Descriptors in Contrast-Enhanced Dual-Energy Mammography: Comparison with MRI

Comparing Diagnostic Pathway of Two Patients Squamous Cell Carcinoma of the Breast-Favourable Diagnostic Input of CESM

A Case of a Concurrent and Co-Located Invasive Carcinoma and a Fibroadenoma to Illustrate the Potential of Dual-Energy, Contrast-Enhanced Digital Mammography on the Diagnosis of Complex Breast Lesions

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