Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis—Comparison to contrast-enhanced breast MRI

Sobrinho

BioMed Research International

et al. 2018

Objective To evaluate the performance of contrast-enhanced mammography (CEM) compared to magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in women with newly diagnosed breast cancer. Methods The institutional review board approved this study. This prospective study included women with newly diagnosed breast cancer who underwent breast CEM and MRI at the end of the last cycle of NAC and before definitive surgery. Size of residual malignancy on post-NAC CEM and MRI was compared with surgical pathology. Agreements and correlations of CEM and MRI measurements with histological size were assessed. Results Thirty-three patients were included with a mean age of 45 years (range 22–76). The sensitivity, specificity, and positive and negative predictive value for detection of residual disease of CEM were 76%, 87.5%, 95%, and 86.4%, and those of MRI were 92%, 75%, 92%, and 75%. Comparing CEM to MRI, the mean difference was −0.8 cm, concordance coefficient was 0.7, and Pearson correlation was 0.7 (p = 0.0003). The concordance coefficient between measurements of each imaging modality and pathologic tumor size was 0.7 for CEM and 0.4 for MRI. Pearson correlation was 0.8 for CEM and 0.5 for MRI. Mean differences between CEM, MRI, and residual histopathological tumor size were 0.8 cm and 1.8 cm, respectively. Conclusions CEM has good correlation and agreement with histopathology for measuring residual disease after NAC. CEM was comparable to MRI, showing high positive predictive value and specificity for detecting residual disease.

Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Mammography (CEM) for Detecting Residual Disease after Neoadjuvant Chemotherapy: A Comparison with Breast Magnetic Resonance Imaging (MRI)

Sobrinho

BioMed Research International

et al. 2018

“…33 Recently, a larger clinical study compared contrast-enhanced and noncontrast-enhanced mammography, breast CT and breast MRI. 34 These authors 34 concluded that all the contrast-enhanced modalities (CEDM, contrast-enhanced breast CT and CEMRI) had higher sensitivity than the conventional (non-contrast) corresponding techniques. For breast cancers, CEDM would be equivalent in diagnostic performance to dynamic CEMRI.…”

Section: Contrast-enhanced Digital Mammography Radiological Imagesmentioning

confidence: 99%

Clinical study of contrast-enhanced digital mammography and the evaluation of blood and lymphatic microvessel density

Brandan

Cruz‐Bastida

Rosado-Méndez

et al. 2016

BJR

Objective: To correlate image parameters in contrastenhanced digital mammography (CEDM) with blood and lymphatic microvessel density (MVD). Methods: 18 Breast Imaging-Reporting and Data System (BI-RADS)-4 to BI-RADS-5 patients were subjected to CEDM. Craniocaudal views were acquired, two views (low and high energy) before iodine contrast medium (CM) injection and four views (high energy) 1-5 min afterwards. Processing included registration and two subtraction modalities, traditional single-energy temporal (highenergy) and "dual-energy temporal with a matrix", proposed to improve lesion conspicuity. Images were calibrated into iodine thickness, and iodine uptake, contrast, time-intensity and time-contrast kinetic curves were quantified. Image indicators were compared with MVD evaluated by anti-CD105 and anti-podoplanin (D2-40) immunohistochemistry. Results: 11 lesions were cancerous and 7 were benign. CEDM subtraction strongly increased conspicuity of lesions enhanced by iodine uptake. A strong correlation was observed between lymphatic vessels and blood vessels; all benign lesions had ,30 blood microvessels per field, and all cancers had more than this value. MVD showed no correlation with iodine uptake, nor with contrast. The most frequent curve was early uptake followed by plateau for uptake and contrast in benign and malignant lesions. The positive-predictive value of uptake dynamics was 73% and that of contrast was 64%. Conclusion: CEDM increased lesion visibility and showed additional features compared with conventional mammography. Lack of correlation between image parameters and MVD is probably due to tumour tissue heterogeneity, mammography projective nature and/or dependence of extracellular iodine irrigation on tissue composition. Advances in knowledge: Quantitative analysis of CEDM images was performed. Image parameters and MVD showed no correlation. Probably, this is indication of the complex dependence of CM perfusion on tumour microenvironment.

“…Malignancies usually undergo a highly angiogenic process, and contrast agent is preferentially taken up by cancerous tissue rather than normal, thus explaining the value of supplemental functional modalities like breast dynamic contrastenhanced MRI (DCE-MRI) and contrast-enhanced digital mammogram (CEDM). DCE-MRI can detect additional breast cancers even after DM and breast clinical examination in averagerisk and high-risk women [3][4][5]. CEDM is superior to DM and DBT in accuracy, and comparable to DCE-MRI in assessing breast malignancy [5].…”

Section: Introductionmentioning

confidence: 95%

Kinetic patterns of benign and malignant breast lesions on contrast enhanced digital mammogram

Huang¹,

Pan²,

Yang³

et al. 2020

PLoS ONE

Self Cite

To evaluate the kinetic patterns of benign and malignant breast lesions using contrastenhanced digital mammogram (CEDM). Methods Women with suspicious breast lesions on mammography or ultrasound were enrolled. Single-view mediolateral oblique (MLO) CEDM of an affected breast was acquired at 2, 3, 4, 7, and 10 min after injection of contrast agent. Three readers visually and semi-quantitatively analyzed the enhancement of suspicious lesions. The kinetic pattern of each lesion was classified as persistent, plateau, or washout over two time intervals, 2-4 min and 2-10 min, by comparing the signal intensity at the first time interval with that at the second. Results There were 73 malignant and 75 benign lesions in 148 patients (mean age: 52 years). Benign and malignant breast lesions showed the highest signal intensity at 3 min and 2 min, respectively. Average areas under receiver operating characteristic (ROC) curve for diagnostic accuracy based on lesion enhancement at different time points were 0.73 at 2 min, 0.72 at 3 min, 0.69 at 4 min, 0.67 at 7 min, and 0.64 at 10 min. Diagnostic performance was significantly better at 2, 3, and 4 min than at 7 and 10 min (all p < 0.05). A washout kinetic pattern was significantly associated with malignant lesions at 2-4 min and 2-10 min frames according to two of the three readers' interpretations (all p � 0.001). Conclusion Applications of optimal time intervals and kinetic patterns show promise in differentiation of benign and malignant breast lesions on CEDM.