Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results

Abstract

Purpose To evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB). Methods The local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41–77 years were included in our study. All patients underwent CESM 2–3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings. Results The sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451–.696), for categorization of BPE from moderate to substantial (κ = .562–.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346–.459). Conclusion In cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.

Upgrade Rate of Percutaneously Diagnosed Pure Atypical Ductal Hyperplasia: Systematic Review and Meta-Analysis of 6458 Lesions

“…The role of preoperative MRI in this setting is debated, with some authors reporting results predicting a low likelihood of malignancy (15,40,109) and others reporting no specific imaging features useful for the prediction of upgrade rate (58). Bicchierai et al (110) proposed contrast material-enhanced mammography to identify low-risk lesions in the absence of Breast Imaging Reporting and Data System descriptors for this technique.…”

Follow‐up of B3 breast lesions without residual microcalcifications post vacuum‐assisted biopsy, can contrast‐enhanced digital mammography help?

“…CEDM was performed using a Selenia Dimensions Mammography System (Hologic). CEDM examination technique is similar to that already described in one of our recent work . Two radiologists reviewed CEDM images in consensus expressing their level of suspicion using the BI‐RADS criteria of breast MRI…”

“…CEDM examination technique is similar to that already described in one of our recent work. 5 Two radiologists Patient No. The mean diameter of each microcalcification cluster was 5.47 mm (range 3-10 mm, SD 2.191).…”

B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

“…Proponents of the surveillance-based approach draw on the actual relatively low grade of treatment personalization and advocate various strategies (such as those implemented in EUSOMA-certified centers) to curtail invasive procedures without engendering underestimation of the subsequent patient-specific risk of developing breast cancer, while opponents point out the absence of standardized protocols and of substantial evidence in favor of extending this approach to a constantly-higher number of B3 subtypes [ 10 , 15 , 40 ]. Generally speaking, while further work-up with contrast-enhanced imaging [ 41 , 42 , 43 , 44 ], predictive models [ 45 , 46 ], and artificial intelligence tools [ 47 ] yielded promising results, none of these approaches has been established as a reliable guide for the management of B3 lesions.…”