Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography and Magnetic Resonance Imaging in Female Patients with Multifocal and Multicentral Breast Cancer

Abstract

Background. The multifocality and multicentrality of breast cancer are the decisive factors influencing surgeon’s choice between breast conserving therapy (BCT) and mastectomy.Methods. The analysis included 71 breast cancer subjects out of 727 patients initially operated on due to breast cancer from January 2013 to April 2019. MG, CESM and MRI were compared with one another in terms of the presence of multifocal/multicentral breast cancers (MFMCC), and assessed for compliance with the postoperative histopathological examination (HP), by calculating the sensitivity and specificity for each of the methods. The aim was to examine which histopathological types of breast cancer were characterised by a more frequent occurrence of MFMCC in relation to the general number of cancers identified in HP. It was also analysed if MRI and CESM changed the planned scope of surgery. Results. The sensitivity of MG in detecting MFMCC was 42.1% (26.31 – 59.18), its specificity, positive (PPV) and negative predictive value (NPV) were 93.9% (79.77 – 99.26), 88.8% and 58.5%, respectively. For CESM, the sensitivity was 84.2% (68.75 – 93.98), its specificity, PVV and NPV were 90.9% (75.67 – 98.08), 91.4%, and 83.3%, respectively. For MRI, all above mentioned parameters were higher, as follow: level of sensitivity 94.7% (82.25 – 99.36), specificity – 93.9% (79.77 – 99.26), PPV – 94.7%, and NPV – 93.9%. In 38 out of 71 patients (53.5%), histopathological examination (HP) confirmed the multifocal and multicentral nature of the breast cancer. Conclusion1. In patients with multifocal/multicentral breast cancer both CESM and MRI are highly sensitive in detection of additional cancer foci. 2. Both CESM and MRI change the extent of surgical intervention in every fourth patient. Trial registration: retrospectively registered