Abstract
Objective
To assess the utility of dual-energy contrast-enhanced spectral mammography (DE-CESM) for evaluation of suspicious malignant microcalcifications.
Methods
Two hundred and fifty-six DE-CESMs were reviewed from 2012–2013, 59 cases fulfilled the following criteria and were enrolled for analysis: (1) suspicious malignant microcalcifications (BI-RADS 4) on mammogram, (2) no related mass, (3) with pathological diagnoses. The microcalcification morphology and associated enhancement were reviewed to analyse the accuracy of the diagnosis and cancer size measurements versus the results of pathology.
Results
Of the 59 microcalcifications, 22 were diagnosed as cancers, 19 were atypical lesions and 18 were benign lesions. Twenty (76.9 %) cancers, three (11.55 %) atypia and three (11.55 %) benign lesions revealed enhancement. The true-positive rate of intermediate- and high-concern microcalcifications was significantly higher than that of low-concern lesions (93.75 % vs. 50 %). Overall, the diagnostic sensitivity of enhancement was 90.9 %, with 83.78 % specificity, 76.92 % positive predictive value, 93.94 % negative predictive value and 86.4 % accuracy. Performance was good (AUC = 0.87) according to a ROC curve and cancer size correlation with a mean difference of 0.05 cm on a Bland-Altman plot.
Conclusions
DE-CESM provides additional enhancement information for diagnosing breast microcalcifications and measuring cancer sizes with high correlation to surgicohistology.
Key Points
• DE-CESM provides additional enhancement information for diagnosing suspicious breast microcalcifications.
• The enhanced cancer size closely correlates to microscopy by Bland-Altman plot.
• DE-CESM could be considered for evaluation of suspicious malignant microcalcifications.
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Abbreviations
- 95 % CI:
-
95 % confidence interval
- ACR:
-
America College of Radiology
- ADH:
-
Atypical ductal hyperplasia
- BI-RADS:
-
Breast Imaging Reporting and Data System
- CC:
-
Craniocaudal
- CESM:
-
Contrast-enhanced Subtracted Mammography
- DCIS:
-
Ductal carcinoma in situ
- DE-CESM:
-
Dual-energy Contrast-enhanced Spectral Mammography
- FEA:
-
Flat epithelial atypia
- FN:
-
False negative
- FP:
-
False positive
- IDC:
-
Invasive ductal carcinoma
- MLO:
-
Mediolateral oblique
- MRI:
-
Magnetic resonance imaging
- Mx:
-
Mammography
- NPV:
-
Negative predictive value
- PPV:
-
Positive predictive value
- ROC:
-
Receiver operating characteristic
- TN:
-
True negative
- TP:
-
True positive
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Acknowledgments
The scientific guarantor of this publication is Dr Yun-Chung Cheung. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. A statistician did the analysis, but was not an author. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Study subjects or cohorts have not been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.
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Cheung, YC., Tsai, HP., Lo, YF. et al. Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis. Eur Radiol 26, 1082–1089 (2016). https://doi.org/10.1007/s00330-015-3904-z
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DOI: https://doi.org/10.1007/s00330-015-3904-z