A Score to Predict the Malignancy of a Breast Lesion Based on Different Contrast Enhancement Patterns in Contrast-Enhanced Spectral Mammography

Abstract

Background: To create a predictive score of malignancy of a breast lesion based on the main contrast enhancement features ascertained by contrast-enhanced spectral mammography (CESM). Methods: In this single-centre prospective study, patients with suspicious breast lesions (BIRADS > 3) were enrolled between January 2013 and February 2022. All participants underwent CESM prior to breast biopsy, and eventually surgery. A radiologist with 20 years’ experience in breast imaging evaluated the presence or absence of enhancement and the following enhancement descriptors: intensity, pattern, margin, and ground glass. A score of 0 or 1 was given for each descriptor, depending on whether the enhancement characteristic was predictive of benignity or malignancy (both in situ and invasive). Then, an overall enhancement score ranging from 0 to 4 was obtained. The histological results were considered the gold standard in the evaluation of the relationship between enhancement patterns and malignancy. Results: A total of 321 women (median age: 51 years; range: 22–83) with 377 suspicious breast lesions were evaluated. Two hundred forty-nine lesions (66%) have malignant histological results (217 invasive and 32 in situ). Considering an overall enhancement score ≥ 2 as predictive of malignancy, we obtain an overall sensitivity of 92.4%; specificity of 89.8%; positive predictive value of 94.7%; and negative predictive value of 85.8%. Conclusions: Our proposed predictive score on the enhancement descriptors of CESM to predict the malignancy of a breast lesion shows excellent results and can help in early breast cancer diagnosis and in avoiding unnecessary biopsies.

Radiomic Features Applied to Contrast Enhancement Spectral Mammography: Possibility to Predict Breast Cancer Molecular Subtypes in a Non-Invasive Manner

“…Many studies confirmed the usefulness of CESM in clinical practice, as well as the usefulness of this relatively new diagnostic method [ 8 , 21 , 22 , 23 ]. CESM appears to offer similar diagnostic performance to MRI with the advantage of being cheaper, faster and applicable to more patients (e.g., patients with claustrophobia and pacemakers) [ 24 ].…”

Contrast-enhanced mammography BI-RADS: a case-based approach to radiology reporting

“…1a and c): enhancement was observed, a nodule with suspicious US characteristics (irregular margins, inhomogeneous, vascularized at color Doppler) was highlighted, which was biopsied with US guidance, leading to an invasive ductal carcinoma diagnosis. This is a typical presentation of invasive ductal carcinoma on CEM [11,17]. The patient subsequently underwent mastectomy with sentinel lymph node biopsy.…”

“…• Screening of high-risk patients with dense breasts is beginning to be considered: CEM appears to demonstrate a superior sensitivity in tumor detection to classical DM and not inferior to tomosynthesis [8,9]. Furthermore, compared with tomosynthesis examinations, preliminary results show that in CEM, the breast is not exposed to a higher average glandular dose [19]. • Surveillance in patients with a prior history of breast cancer: CEM proves to be an excellent tool for use in the surveillance of oncological patients [20].…”

“…Numerous studies have confirmed CEM's utility and diagnostic performance in clinical settings [8]. However, until recently, a major drawback of this method was the lack of standardization in reporting the findings that radiologists may encounter [9][10][11][12].…”

How Radiomics Can Improve Breast Cancer Diagnosis and Treatment

“…Nowadays, MRI is accepted as the most sensitive imaging technique for detecting and staging breast cancer and is of great help in the study of particularly complex breasts, or of patients with an elevated hereditary–familial risk of developing breast cancer [ 35 ]. With a similar performance to MRI, CESM can also visualize microcalcifications and possibly reduce the rate of false-positive findings and benign biopsies [ 32 , 36 ].…”