Contrast-Enhanced Mammographic Features of In Situ and Invasive Ductal Carcinoma Manifesting Microcalcifications Only: Help to Predict Underestimation?

Cheung, Yun‐Chung; Chen, Kueian; Yu, Chung‐Shan; Ueng, Shir-Hwa; Li, Chia-Wei; Chen, Shin‐Cheh

doi:10.3390/cancers13174371

Cited by 15 publications

(7 citation statements)

References 26 publications

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“…IDC lesions presented higher enhancement than that of DCIS. Our data also showed that non-mass lesions with mild enhancements or clustered microcalcification lesions with mild enhancements were closely related to DCIS (100%, 5/5), which was concordant with that of the previous literature description [ 24 ]. This was speculated to be associated with more aggressive behavior and abundant blood flow of IDC than DCIS.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Contrast‐Enhanced Spectral Mammography and Contrast‐Enhanced MRI in Screening Multifocal and Multicentric Lesions in Breast Cancer Patients

Feng¹,

Lei

Zhang

et al. 2022

Contrast Media & Molecular Imaging

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Objectives. We aimed to determine the difference between contrast-enhanced spectral mammography (CESM) and contrast-enhanced magnetic resonance imaging (CE-MRI) in detecting multifocal and multicentric breast cancer (MMBC). Methods: This study was conducted among breast cancer patients between July 1, 2017, and May 30, 2021. The sensitivity, specificity, and accuracy of CESM and CE-MRI in the diagnosis of MMBC were evaluated with pathological results as the gold standard. Results. A total of 188 lesions were detected in 54 patients with MMBC, including 177 breast cancer and 11 benign lesions. Based on CESM and CE-MRI, 4 false-positive cases and 3 false-negative cases and 7 false-positive cases and 1 false-negative case, respectively, were found. The accuracy of CESM was higher than that of MRI (96.3% vs 95.7%), and the specificity was higher than that of MRI (63.6% vs 36.4%). There were no significant differences in the sensitivity, specificity, and accuracy for the detection of MMBC between CESM and CE-MRI (p = 0.500; p = 0.250; p = 0.792). Conclusion. CESM is an effective method for the detection of MMBC, which is consistent with the sensitivity and accuracy of CE-MRI.

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Section: Discussionsupporting

confidence: 92%

Comparison of Contrast‐Enhanced Spectral Mammography and Contrast‐Enhanced MRI in Screening Multifocal and Multicentric Lesions in Breast Cancer Patients

Feng¹,

Lei

Zhang

et al. 2022

Contrast Media & Molecular Imaging

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“…As already reported [ 29 – 31 ], the negative predictive value of rCEM images for suspicious calcifications remains to be ascertained and, in our opinion, only large-scale dedicated studies will allow to solve this issue, especially also addressing DCIS overdiagnosis. Options in this direction involve the identification of characteristic enhancement patterns for cancers of low biological relevance [ 37 ] and the application of artificial intelligence–driven radiomic analysis [ 38 ]. The latter could be particularly useful considering how interpretation thresholds are influenced by the more equivocal visual conspicuity of lesion enhancement in rCEM images than in CE-MRI, compared to standard background parenchymal enhancement.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced mammography for the assessment of screening recalls: a two-centre study

et al. 2022

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Objectives To evaluate the potential of contrast-enhanced mammography (CEM) for reducing the biopsy rate of screening recalls. Methods Recalled women were prospectively enrolled to undergo CEM alongside standard assessment (SA) through additional views, tomosynthesis, and/or ultrasound. Exclusion criteria were symptoms, implants, allergy to contrast agents, renal failure, and pregnancy. SA and CEM were independently evaluated by one of six radiologists, who recommended biopsy or 2-year follow-up. Biopsy rates according to SA or recombined CEM (rCEM) were compared with the McNemar’s test. Diagnostic performance was calculated considering lesions with available final histopathology. Results Between January 2019 and July 2021, 220 women were enrolled, 207 of them (median age 56.6 years) with 225 suspicious findings analysed. Three of 207 patients (1.4%) developed mild self-limiting adverse reactions to iodinated contrast agent. Overall, 135/225 findings were referred for biopsy, 90/225 by both SA and rCEM, 41/225 by SA alone and 4/225 by rCEM alone (2/4 being one DCIS and one invasive carcinoma). The rCEM biopsy rate (94/225, 41.8%, 95% CI 35.5–48.3%) was 16.4% lower (p < 0.001) than the SA biopsy rate (131/225, 58.2%, 95% CI 51.7–64.5%). Considering the 124/135 biopsies with final histopathology (44 benign, 80 malignant), rCEM showed a 93.8% sensitivity (95% CI 86.2–97.3%) and a 65.9% specificity (95% CI 51.1–78.1%), all 5 false negatives being ductal carcinoma in situ detectable as suspicious calcifications on low-energy images. Conclusions Compared to SA, the rCEM-based work-up would have avoided biopsy for 37/225 (16.4%) suspicious findings. Including low-energy images in interpretation provided optimal overall CEM sensitivity. Key Points • The work-up of suspicious findings detected at mammographic breast cancer screening still leads to a high rate of unnecessary biopsies, involving between 2 and 6% of screened women. • In 207 recalled women with 225 suspicious findings, recombined images of contrast-enhanced mammography (CEM) showed a 93.8% sensitivity and a 65.9% specificity, all 5 false negatives being ductal carcinoma in situ detectable on low-energy images as suspicious calcifications. • CEM could represent an easily available one-stop shop option for the morphofunctional assessment of screening recalls, potentially reducing the biopsy rate by 16.4%.

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“…This may be important when evaluating those patients in whom a diagnostic underestimation (those patients who have an in-situ neoplasm as a result of biopsy and are found to have an infiltrating neoplasm at surgery) of the biopsy with results of DCIS is suspected: a particular type of enhancement may lead to suspect an invasive lesion rather than an in situ one [ 46 , 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

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

Nicosia

Bozzini

Palma

et al. 2022

Cancers

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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.

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Contrast-Enhanced Mammographic Features of In Situ and Invasive Ductal Carcinoma Manifesting Microcalcifications Only: Help to Predict Underestimation?

Cited by 15 publications

References 26 publications

Comparison of Contrast‐Enhanced Spectral Mammography and Contrast‐Enhanced MRI in Screening Multifocal and Multicentric Lesions in Breast Cancer Patients

Comparison of Contrast‐Enhanced Spectral Mammography and Contrast‐Enhanced MRI in Screening Multifocal and Multicentric Lesions in Breast Cancer Patients

Contrast-enhanced mammography for the assessment of screening recalls: a two-centre study

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

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