Association between lesion enhancement and breast cancer in contrast-enhanced spectral mammography

Abstract

Background Contrast-enhanced spectral mammography (CESM) may help to determine the malignancy potential of lesions according to the degree of enhancement. Purpose To investigate the correlation between the degree of contrast enhancement of the lesions in contrast-enhanced spectral mammography (CESM) and the final histopathological diagnosis in patients with BI-RADS 4 and 5 lesions. Material and Methods CESM was performed in 128 patients who had BI-RADS 4 and 5 lesions on mammography and underwent histopathological examination. A total of 128 index lesions were scored using a 4-point scale regarding the degree of contrast enhancement (0 = no contrast enhancement, 1 = minimal, 2 = moderate, 3 = marked), a score of 2 and 3 was accepted as suggestive of malignancy. The study was approved in our institutional scientific committee. Results In total, 76 (59.4%) of the lesions had benign histopathological results, whereas 52 of them had malignant results. Contrast enhancement was not observed in 22.7% of the lesions while 24.2% had minimal enhancement, 18.8% had moderate enhancement, and 34.4% had marked enhancement in CESM. The sensitivity of the degree of contrast enhancement in CESM was 98.1%, when the specificity was 77.6%, positive predictive value was 75%, negative predictive value was 98.3%, and accuracy was 85.9%. Conclusion This study demonstrated that the degree of contrast enhancement of the lesions in CESM may be used in daily practice with easily performing a visual scale in predicting the malignancy potential of the lesions.

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

“…In this scenario, it is now well-known that CESM could represent a reliable imaging adjunct [ 29 , 30 , 31 , 32 ] for the early detection of BC, by coupling sensitivity to specificity, thus, representing a possible solution to the weaknesses of the main diagnostic methods. However, it is still poorly understood what and how many contrastographic enhancement features (and their possible combinations) of a breast lesion occur during CESM, and how they can be used to effectively predict the malignancy of a lesion [ 33 , 34 , 35 , 36 ].…”