Adding the power of iodinated contrast media to the credibility of mammography in breast cancer diagnosis

Abstract

Dual-energy contrast-enhanced spectral mammography (CESM) represents a relatively new diagnostic tool adjunct to mammography. The aim of this study was to strengthen the breast imaging-reporting and data system (BIRADS) classification score in order to improve early breast cancer diagnosis. For this reason, we propose a sum score, termed malignancy potential score (MPS), incorporating the standard BIRADS score and our proposed CESM score. From September 2014 to September 2015, 216 females (age range, 26-85 years; mean age 54.6 years) underwent CESM evaluation of mammographic findings that were primarily assessed as BIRADS 2-5. 10 of these patients had bilateral findings; a total of 226 lesions were examined. High-energy image evaluation was based on the intensity of contrast enhancement of the lesion compared with background enhancement, categorized as Type -1, 0, 1 or 2 enhancement. Histopathology reports were compared with imaging assessment. 98 of 226 lesions were malignant and 128 of 226 lesions were benign. The area under the curve was 0.843, 0.888 and 0.917 for mammographic BIRADS score, CESM score and MPS, respectively, with p-value , 0.05. The sensitivity, specificity and accuracy rates were 91.83, 80.47 and 85.40%, respectively, when a best MPS cut-off point of 4 was used. The malignancy potential score (MPS) has higher diagnostic performance than digital mammography or CESM alone. MPS empowers the credibility of the digital mammography BIRADS score and our proposed type of enhancement in dual-energy CESM and is a diagnostic tool that increases the accuracy rate in early breast cancer diagnosis.

Diagnostic value of the enhancement intensity and enhancement pattern of CESM to benign and malignant breast lesions

“…Tsigginou et al highlighted that the combination of BI–RADS and CESM enhancement intensity can differentiate benign and malignant breast lesions better than by using BI–RADS alone. [ 14 ] However, they did not include CESM enhancement patterns. The breast MRI imaging section of the BI–RADS 2013 edition emphasized that homogeneous enhancement is an indication of benign lesions, whereas heterogeneous enhancement is a feature of malignant lesions.…”

Contrast-enhanced mammography: past, present, and future

“…Reporting should also include an assessment of breast density based on low-energy images and background parenchymal enhancement (BPE) using recombined images. A "malignancy potential score" (MPS) has been proposed by Tsigginou et al [15] for final assessment reporting. This aggregate score combines the standard mammography BI-RADS score and a CEM score based on a 4-level scale of lesion enhancement ranging from negative to intense enhancement.…”

“…Not all enhancing lesions on CEM are malignant, resulting in falsepositive findings. Benign enhancing findings may include fibroadenoma, atypical ductal hyperplasia, papilloma, pseudoangiomatous stromal hyperplasia, abscess, and radial scar or complex sclerosing lesion [15,24].…”

Control of optical transparency and infrared laser heating of costal cartilage via injection of iohexol

“…Iohexol solution is allowed for medical application and originally presents a kind of iodinated contrast media widely used in radiography of internal organs , intravascular monitoring , tumor metastases detection and contrast enhanced cartilage visualization including procedures where IR irradiation is carried out such as laser reconstruction of interverbal disc . Additionally, it was shown as effective OCA for hyaline‐type cartilage in visible and infrared spectral range near water transparency window .…”