Differential Diagnostics of Breast Pathology Using Contrast Enhancement Patterns in Contrast-Enhanced Spectral Mammography

Abstract

Dual-energy contrast-enhanced spectral mammography (CESM) is a new promising method for visualizing pathological changes in breast, which combines digital mammography and a functional assessment of vascularization using intravenous contrast ehnancement. According to accumulated experience CESM is well tolerated by patients and is similar to magnetic resonance imaging with dynamic contrast enhancement (MRI with DCE), but at the same time, CESM is more affordable and can be performed in patients with contraindications for MRI. However, few studies have been conducted to evaluate the role of CESM. In the world literature, interpretation of contrast images is based only on the degree of accumulation of the contrast agent, but we propose a more detailed assessment of the structure of the hypervascular lesions by highlighting the contrast enhancement patterns. Objective: to determine the diagnostic effectiveness of CESM using the contrast enhancement patterns in malignant and benign lesions. Materials and methods. 239 women with suspicious for breast cancer lesions were examined from August 2018 to December 2019. The mean age of the women was 51 years. 322 lesions were revealed, 149 (46.3%) were malignant, 173 (53.7%) were benign. All lesions were histologically confirmed. As a result of the analysis of our data, 9 types of contrast enhancement patterns were distinguished: reticulate, granular, annular, diffuse-spherical, lacunar, cloud-like, heterogeneous-annular, point, cotton-like. Results. Using an additional diagnostic feature - contrast enhancement patterns in lesions, increased the sensitivity of CESM from 91.3% to 98.0% (p=0.26), specificity from 80.3% to 93, 6% (p=0.013), accuracy from 85.4 to 95.7% (p=0.004) in comparison with using of only one feature of contrast enhancement intensity in the differential diagnosis of malignant and benign lesions. Conclusion: thus, this approach of interpreting subtraction images allows to increase the efficiency of CESM in diagnosis of breast cancer.