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Grażyńska A, Niewiadomska A, Owczarek AJ, Winder M, Hołda J, Zwolińska O, Barczyk-Gutkowska A, Modlińska S, Lorek A, Kuźbińska A, Steinhof-Radwańska K. Comparison of the effectiveness of contrast-enhanced mammography in detecting malignant lesions in patients with extremely dense breasts compared to the all-densities population. Pol J Radiol 2024; 89:e240-e248. [PMID: 38938658 PMCID: PMC11210381 DOI: 10.5114/pjr/186180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/17/2024] [Indexed: 06/29/2024] Open
Abstract
Purpose To assess the effectiveness of contrast-enhanced mammography (CEM) recombinant images in detecting malignant lesions in patients with extremely dense breasts compared to the all-densities population. Material and methods 792 patients with 808 breast lesions, in whom the final decision on core-needle biopsy was made based on CEM, and who received the result of histopathological examination, were qualified for a single-centre, retrospective study. Patient electronic records and imaging examinations were reviewed to establish demographics, clinical and imaging findings, and histopathology results. The CEM images were reassessed and assigned to the appropriate American College of Radiology (ACR) density categories. Results Extremely dense breasts were present in 86 (10.9%) patients. Histopathological examination confirmed the presence of malignant lesions in 52.6% of cases in the entire group of patients and 43% in the group of extremely dense breasts. CEM incorrectly classified the lesion as false negative in 16/425 (3.8%) cases for the whole group, and in 1/37 (2.7%) cases for extremely dense breasts. The sensitivity of CEM for the group of all patients was 96.2%, specificity - 60%, positive predictive values (PPV) - 72.8%, and negative predictive values (NPV) - 93.5%. In the group of patients with extremely dense breasts, the sensitivity of the method was 97.3%, specificity - 59.2%, PPV - 64.3%, and NPV - 96.7%. Conclusions CEM is characterised by high sensitivity and NPV in detecting malignant lesions regardless of the type of breast density. In patients with extremely dense breasts, CEM could serve as a complementary or additional examination in the absence or low availability of MRI.
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Affiliation(s)
- Anna Grażyńska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Niewiadomska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Aleksander J. Owczarek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Mateusz Winder
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Jakub Hołda
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Olga Zwolińska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Anna Barczyk-Gutkowska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Sandra Modlińska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Katowice, Poland
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Wang L, Wang P, Shao H, Li J, Yang Q. Role of contrast-enhanced mammography in the preoperative detection of ductal carcinoma in situ of the breasts: a comparison with low-energy image and magnetic resonance imaging. Eur Radiol 2024; 34:3342-3351. [PMID: 37853174 DOI: 10.1007/s00330-023-10312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 08/13/2023] [Accepted: 08/20/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To compare contrast-enhanced mammography (CEM) with low-energy image (LEI) alone and with magnetic resonance imaging (MRI) in the preoperative diagnosis of ductal carcinoma in situ (DCIS). METHODS In this single-center retrospective study, we reviewed 98 pure DCIS lesions in 96 patients who underwent CEM and MRI within 2 weeks preoperatively. The diagnostic performances of each imaging modality, lesion morphology, and extent were evaluated. RESULTS The sensitivity of CEM to DCIS was similar to that of MRI (92.9% vs. 93.9%, p = 0.77) and was significantly higher than that of LEI alone (76.5%, p = 0.002). The sensitivity of CEM to calcified DCIS (92.4%) was not significantly different from LEI alone (92.4%) and from MRI (93.9%, p = 1.00). However, CEM contributed to the simultaneous comparison of calcifications with enhancements. CEM had considerably higher sensitivity compared with LEI alone (93.8% vs. 43.8%, p < 0.001) and performed similarly to MRI (93.8%, p = 1.00) for noncalcified DCIS. All DCIS lesions were enhanced in MRI, whereas 94.9% (93/98) were enhanced in CEM. Non-mass enhancement was the most common presentation (CEM 63.4% and MRI 66.3%). The difference between the lesion size on each imaging modality and the histopathological size was smallest in MRI, followed by CEM, and largest in LEI. CONCLUSION CEM was more sensitive than LEI alone and comparable to MRI in DCIS diagnosis. The enhanced morphology of DCIS in CEM was consistent with that in MRI. CEM was superior to LEI alone in size measurement of DCIS. CLINICAL RELEVANCE STATEMENT This study investigated the value of CEM in the diagnosis and evaluation of DCIS, aiming to offer a reference for the selection of examination methods for DCIS and contribute to the early diagnosis and precise treatment of DCIS. KEY POINTS • DCIS is an important indication for breast surgery. Early and accurate diagnosis is crucial for DCIS treatment and prognosis. • CEM overcomes the deficiency of mammography in noncalcified DCIS diagnosis, exhibiting similar sensitivity to MRI; and CEM contributes to the comparison of calcification and enhancement of calcified DCIS, thereby outperforming MRI. • CEM is superior to LEI alone and slightly inferior to MRI in the size evaluation of DCIS.
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Affiliation(s)
- Liping Wang
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People's Republic of China
| | - Ping Wang
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People's Republic of China
| | - Huafei Shao
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People's Republic of China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264100, Shandong, People's Republic of China
| | - Qinglin Yang
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People's Republic of China.
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Açar ÇR, Orguc S. Comparison of Performance in Diagnosis and Characterization of Breast Lesions: Contrast-Enhanced Mammography Versus Breast Magnetic Resonance Imaging. Clin Breast Cancer 2024:S1526-8209(24)00107-1. [PMID: 38777678 DOI: 10.1016/j.clbc.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/31/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION In contemporary medical practice, magnetic resonance imaging (MRI) is the most sensitive modality for detecting breast cancer. Contrast-enhanced mammography (CEM), a relatively recent technology, represents another contrast-enhanced imaging technique that has the potential to serve as an alternative to breast MRI. Our main goal is to compare the diagnostic accuracy including assessment of sensitivity and specificity of these 2 contrast-enhanced breast imaging methods, CEM and MRI, in the diagnosis and characterization of breast lesions. MATERIAL AND METHODS Our prospective study included patients who were clinically suspected of malignancy and/or had suspicious findings detected by mammography or ultrasound. A total of 116 patients were included, and both CEM and MRI examinations were performed on all patients. All CEM examinations were conducted at our institution, while 56.89% of all MRI examinations were carried out at external centers. While histopathological results were accessible for all malignant lesions, the final diagnosis for 80.5% of benign lesions was established through typical imaging findings and adequate follow-up. RESULTS This study encompassed a total of 219 lesions, with 125 out of 219 (57.07%) malignant lesions and 94 out of 219 (42.92%) benign lesions. The sensitivity and specificity values were 98.40% and 81.91%, respectively, for CEM, and 100% and 75.33%, respectively, for MRI. Moreover, CEM showcased comparable performance to MRI in evaluating women with dense breasts. CONCLUSION CEM and MRI were compared for breast lesion diagnosis, with MRI showing higher sensitivity and CEM higher specificity; however, the differences were not statistically significant.
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Affiliation(s)
- Çağdaş Rıza Açar
- Department of Radiology, Manisa Celal Bayar University, Uncubozköy, Yunusemre, Manisa 45030, Türkiye.
| | - Sebnem Orguc
- Department of Radiology, Manisa Celal Bayar University, Uncubozköy, Yunusemre, Manisa 45030, Türkiye
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Lin S, Li H, Li Y, Chen Q, Ye J, Lin S, Cai S, Sun J. Diagnostic performance of contrast-enhanced mammography for suspicious findings in dense breasts: A systematic review and meta-analysis. Cancer Med 2024; 13:e7128. [PMID: 38659408 PMCID: PMC11043676 DOI: 10.1002/cam4.7128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE Contrast-enhanced spectral imaging (CEM) is a new mammography technique, but its diagnostic value in dense breasts is still inconclusive. We did a systematic review and meta-analysis of studies evaluating the diagnostic performance of CEM for suspicious findings in dense breasts. MATERIALS AND METHODS The PubMed, Embase, and Cochrane Library databases were searched systematically until August 6, 2023. Prospective and retrospective studies were included to evaluate the diagnostic performance of CEM for suspicious findings in dense breasts. The QUADAS-2 tool was used to evaluate the quality and risk of bias of the included studies. STATA V.16.0 and Review Manager V.5.3 were used to meta-analyze the included studies. RESULTS A total of 10 studies (827 patients, 958 lesions) were included. These 10 studies reported the diagnostic performance of CEM for the workup of suspicious lesions in patients with dense breasts. The summary sensitivity and summary specificity were 0.95 (95% CI, 0.92-0.97) and 0.81 (95% CI, 0.70-0.89), respectively. Enhanced lesions, circumscribed margins, and malignancy were statistically correlated. The relative malignancy OR value of the enhanced lesions was 28.11 (95% CI, 6.84-115.48). The relative malignancy OR value of circumscribed margins was 0.17 (95% CI, 0.07-0.45). CONCLUSION CEM has high diagnostic performance in the workup of suspicious findings in dense breasts, and when lesions are enhanced and have irregular margins, they are often malignant.
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Affiliation(s)
- Shu‐ting Lin
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Hong‐jiang Li
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Yi‐zhong Li
- Department of BoneThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Qian‐qian Chen
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Jia‐yi Ye
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Shu Lin
- Center of Neurological and Metabolic ResearchThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
- Department of Neuroendocrinology, Group of NeuroendocrinologyGarvan Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Si‐qing Cai
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Jian‐guo Sun
- Department of Urinary SurgeryThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
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Yang D, Gong F. Comparative Evaluation of Contrast-Enhanced Spectral Mammography and Digital Breast Tomosynthesis for Diagnosing and Treating Breast Cancer. Med Sci Monit 2023; 29:e941880. [PMID: 38087777 PMCID: PMC10726607 DOI: 10.12659/msm.941880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of contrast-enhanced spectral mammography (CESM) and digital breast tomosynthesis (DBT) in the diagnosis and chemotherapy of breast cancer. MATERIAL AND METHODS We retrospectively analyzed data on 125 lesions of 115 patients with breast diseases in Lanzhou First People's Hospital from January 2020 to June 2022. Patients were examined by digital breast tomographic fusion and contrast-enhanced spectral mammography after chemotherapy. We compared the diagnostic accuracy of the 2 imaging techniques, and the diagnostic efficacy was evaluated with ROC curves. RESULTS There were significant differences in the type and degree of CESM enhancement between benign and malignant lesions. Malignant lesions mostly showed moderate to severe enhancement, while benign lesions mostly showed mild to moderate enhancement. There was no significant difference in DBT manifestations between benign and malignant lesions. After neoadjuvant chemotherapy, 88 patients had pathological remission, and the remission rate was 70.40%. Thirty-seven patients did not respond (nonresponse rate: 29.60%). The accuracy of CESM lesion size assessment was 84.00% (105/125), with high consistency. The accuracy of DBT lesion size assessment was 68.00% (85/125), and the consistency was poor. BI-RADS 4B was the truncation point. CESM had significantly higher sensitivity, specificity, accuracy, positive predictive value, and negative predictive value than DBT. In premenopausal patients and patients aged less than 50 years, the diagnostic efficacy of DBT and CESM was significantly different. CONCLUSIONS The diagnostic efficacy of CESM was significantly better than DBT in premenopausal women and patients under age 50. Diagnosis and treatment of breast diseases may be enhanced by the use of CESM.
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Affiliation(s)
- Di Yang
- Department of Radiology, Lanzhou First People’s Hospital, Lanzhou, Gansu, PR China
| | - Fei Gong
- Department of Oncology, Lanzhou First People’s Hospital, Lanzhou, Gansu, PR China
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Kang Y, Li Z, Yang G, Xue J, Zhang L, Rong X. Diagnostic performance of the Kaiser score in the evaluation of breast lesions on contrast-enhanced mammography. Eur J Radiol 2022; 156:110524. [PMID: 36126352 DOI: 10.1016/j.ejrad.2022.110524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to investigate whether the Kaiser score (KS) could improve the diagnostic performance of breast imaging reporting and data system (BI-RADS) in evaluating breast enhancing lesions on contrast-enhanced mammography (CEM). METHODS Three hundred fifty-nine patients with 375 lesions (231 malignant and 144 benign) were included in this retrospective study from April 2019 to December 2021.Two readers with different levels of experience in breast imaging were asked to give a BI-RADS assessment category according to the CEM BI-RADS and final score based on the KS. The diagnostic performance of all lesions, mass and non-mass enhancement (NME) were assessed by receiver operating characteristic (ROC) analysis, and the areas under the ROC curve (AUCs) were measured. The weighted kappa coefficients were calculated to investigate the interreader agreement. RESULTS The AUCs of the KS for all lesions were 0.915 (95 %CI: 0.884-0.947) and 0.876 (95 %CI: 0.838-0.914) for two readers. When mass and NME were evaluated separately, the AUCs of the KS for mass were higher than those for NME (p < 0.001). The AUCs of BI-RADS for all lesion diagnoses ranged between 0.821 (95 %CI: 0.778-0.864) and 0.842(95 %CI: 0.801-0.883) for two readers. The AUCs of the KS were higher than those of BI-RADS (p < 0.001, p = 0.016). There were no significant differences in the sensitivity between the KS (97.4 %) and BI-RADS (99.6 %) for all lesions (p = 0.130). The specificity of the KS was significantly higher than that of BI-RADS (p < 0.001). Compared with BI-RADS, the application of the KS could have potentially obviated 41.7 % to 47.9 % unnecessary biopsies in 144 benign lesions. Interreader agreement between the two readers of the KS was almost perfect (k = 0.883 [95 % CI: 0.842-0.924]). CONCLUSION The use of the KS provided a high diagnostic performance in distinguishing malignant and benign breast lesions on CEM and outperformed BI-RADS. The application of the KS can downgrade up to 47.9% of unnecessary biopsies of benign breast lesions.
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Affiliation(s)
- Yihe Kang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Zhigang Li
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Guang Yang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Jing Xue
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Lingling Zhang
- Department of Pathology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Xiaocui Rong
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
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Mahdavi R, Mehrvarz S, Hoseinpour P, Yousefpour N, Abbasvandi F, Tayebi M, Ataee H, Parniani M, Abdolhoseini S, Hajighasemi F, Nourinejad Z, Shojaeian F, Ghafari H, Nikshoar MS, Abdolahad M. Intra-radiological pathology-calibrated Electrical Impedance Spectroscopy in the evaluation of excision-required breast lesions. Med Phys 2022; 49:2746-2760. [PMID: 35107181 DOI: 10.1002/mp.15481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/14/2022] [Accepted: 01/08/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Evaluating a real-time complementary bioelectrical diagnostic device based on Electrical Impedance Spectroscopy(EIS) for improving breast imaging-reporting and data system (BIRADS) scoring accuracy, especially in high-risk or borderline breast diseases. The primary purpose is to characterize breast tumors based on their dielectric properties. Early detection of high-risk lesions and increasing the accuracy of tumor sampling and pathological diagnosis are secondary objectives of the study. METHODS The tumor detection probe (TDP) was first applied to the mouse model for electrical safety evaluations by electrical current measurement, then to 138 human palpable breast lesions undergo CNB, VAB, or FNA with the surgeon's requests. Impedance phase slope(IPS) in frequency ranges of 100 kHz to 500 kHz and impedance magnitude in f = 1kHz were extracted as the classification parameters. Consistency of radiological and pathological declarations for the excisional recommendation was then compared with the IPS values. RESULTS Considering pathological results as the gold standard, meaningful correlations between IPS and pathophysiological status of lesions recommended for excision (such as atypical ductal hyperplasia, papillary lesions, complex sclerosing adenosis, and fibroadenoma, etc.) were observed (p<0.0001). These pathophysiological properties may include cells size, membrane permeability, packing density, adenosis, cytoplasm structure, etc. Benign breast lesions showed IPS values greater than zero, while high-risk proliferative, precancerous, or cancerous lesions had negative IPS values. Statistical analysis showed 95% sensitivity with Area Under the Curve(AUC) equal to 0.92. CONCLUSION Borderline breast diseases and high-risk lesions that should be excised according to standard guidelines can be diagnosed with TDP before any sampling process. It is a precious outcome for high-risk lesions that are radiologically underestimated to BI-RADS3, specifically in younger patients with dense breast masses, challenging in mammographic and sonographic evaluations. Also, the lowest IPS value detects the most pathologic portions of the tumor for increasing sampling accuracy in large tumors. SIGNIFICANCE Precise detection of high-risk breast masses, which may be declared BI-RADS3 instead of BI-RADS4a. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Reihane Mahdavi
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran
| | - Sajad Mehrvarz
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran
| | - Parisa Hoseinpour
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,SEPAS Pathology Laboratory, P.O.Box: 1991945391, Tehran, Iran
| | - Narges Yousefpour
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran
| | - Fereshte Abbasvandi
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,ATMP Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, P.O. BOX 15179/64311, Tehran, Iran
| | - Mahtab Tayebi
- Radiology Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, P.O. BOX 15179/64311, Tehran, Iran
| | - Hossein Ataee
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran
| | - Mohammad Parniani
- Pathology Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, P.O. BOX 15179/64311, Tehran, Iran
| | - Saeed Abdolhoseini
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran
| | - Fateme Hajighasemi
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran
| | - Zeinab Nourinejad
- Pathology Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, P.O. BOX 15179/64311, Tehran, Iran
| | - Fateme Shojaeian
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,School of Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box: 19615-1179, Tehran, Iran
| | - Hadi Ghafari
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran
| | - Mohammad Saeed Nikshoar
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran
| | - Mohammad Abdolahad
- Nano Bioelectronics Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Nano Electronic Center of Excellence, Nano Bio Electronics Devices Lab, School of Electrical and Computer Engineering, University of Tehran, P.O. Box 14395/515, Tehran, Iran.,Cancer Institute, Imam-Khomeini Hospital, Tehran University of Medical Sciences, P.O. Box:1419733141, Tehran, Iran
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Cozzi A, Magni V, Zanardo M, Schiaffino S, Sardanelli F. Contrast-enhanced Mammography: A Systematic Review and Meta-Analysis of Diagnostic Performance. Radiology 2021; 302:568-581. [PMID: 34904875 DOI: 10.1148/radiol.211412] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Contrast-enhanced mammography (CEM) is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. Purpose To perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Materials and Methods The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as the reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Summary diagnostic odds ratio and area under the receiver operating characteristic curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results Sixty studies (67 study parts, 11 049 CEM examinations in 10 605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled diagnostic odds ratio was 55.7 (95% CI: 42.7, 72.7) with high heterogeneity (τ2 = 0.3). At meta-regression, CEM interpretation with both low-energy and recombined images had higher sensitivity (95% vs 94%, P < .001) and specificity (81% vs 71%, P = .03) compared with recombined images alone. At subgroup analysis, CEM showed a 95% pooled sensitivity (95% CI: 92, 97) and a 78% pooled specificity (95% CI: 66, 87) from nine studies in patients with dense breasts, while in 10 studies on mammography-detected suspicious findings, CEM had a 92% pooled sensitivity (95% CI: 89, 94) and an 84% pooled specificity (95% CI: 73, 91). Conclusion Contrast-enhanced mammography demonstrated high performance in breast cancer detection, especially with joint interpretation of low-energy and recombined images. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Bahl in this issue.
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Affiliation(s)
- Andrea Cozzi
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Veronica Magni
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Moreno Zanardo
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Simone Schiaffino
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Francesco Sardanelli
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
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Woodard S, Murray A. Contrast-Enhanced Mammography: Reviewing the Past and Looking to the Future. Semin Roentgenol 2021; 57:126-133. [DOI: 10.1053/j.ro.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
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Mohamed SAS, Moftah SG, Chalabi NAEM, Salem MAAW. Added value of contrast-enhanced spectral mammography in symptomatic patients with dense breasts. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00372-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast cancer is the most common malignancy in females around the world representing 25.1% of all cancers.
The high prevalence and need for early treatment of breast malignancy highlight the importance of early and accurate diagnosis. In order to achieve this target, it is necessary to select the most appropriate modality for investigation.
Early detection of breast cancer by conventional mammography tends to reduce mortality; however, it has a low sensitivity and specificity in young females with dense breasts owing to reduced contrast between a possible tumor and the surrounding breast tissue with superimposition of the glandular tissue obscuring underlying lesions.
Our study included 25 patients with dense breasts presented with different breast symptoms, yet the breast lump was the most common complaint. The aim of our study is to evaluate the supplementary value of contrast-enhanced spectral mammography in the assessment of symptomatic patients with dense breasts.
Results
In our study, the enrolled subjects underwent both contrast-enhanced spectral mammography (CESM) and conventional full-field digital mammography (FFDM). CESM was shown to be better than FFDM in terms of sensitivity, positive predictive value, negative predictive value, and accuracy, measuring 100%, 77.8%, 100%, and 84%, compared to 56%, 75%, 46%, and 60%, respectively, yet both modalities showed low specificity, measuring 63.6% and 66.6% for CESM and FFDM, respectively.
The added value of CESM was assessed in terms of ability to detect and correctly characterize the lesions in correlation to histopathological results where CESM could detect 88% of the lesions included in our study and correctly characterized 84% of the lesions; on the other side, FFDM detected only 20% of the lesions and correctly characterized 60% of the lesions. CESM changed the treatment plan to a more extensive surgery +/− neoadjuvant chemotherapy in 57% out of fourteen cases diagnosed with breast cancer emphasizing the role of CESM in assessing the extent of the disease, multicentricity, and multifocality and consequently tailoring the most appropriate treatment plan suitable for each patient.
Conclusion
Contrast-enhanced spectral mammography is superior to full-field digital mammography in patients with dense breasts with a significant supplementary value in detection, characterization of lesions, and tailoring the appropriate treatment plan.
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Steinhof-Radwańska K, Lorek A, Holecki M, Barczyk-Gutkowska A, Grażyńska A, Szczudło-Chraścina J, Bożek O, Habas J, Szyluk K, Niemiec P, Gisterek I. Multifocality and Multicentrality in Breast Cancer: Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography, and Magnetic Resonance Imaging in a Group of Patients with Primarily Operable Breast Cancer. Curr Oncol 2021; 28:4016-4030. [PMID: 34677259 PMCID: PMC8534697 DOI: 10.3390/curroncol28050341] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The multifocality and multicentrality of breast cancer (MFMCC) are the significant aspects that determine a specialist's choice between applying breast-conserving therapy (BCT) or performing a mastectomy. This study aimed to assess the usefulness of mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in women diagnosed with breast cancer before qualifying for surgical intervention to visualize other (additional) cancer foci. METHODS The study included 60 breast cancer cases out of 630 patients initially who underwent surgery due to breast cancer from January 2015 to April 2019. MG, CESM, and MRI were compared with each other in terms of the presence of MFMCC and assessed for compliance with the postoperative histopathological examination (HP). RESULTS Histopathological examination confirmed the presence of MFMCC in 33/60 (55%) patients. The sensitivity of MG in detecting MFMCC was 50%, and its specificity was 95.83%. For CESM, the sensitivity was 85.29%, and the specificity was 96.15%. For MRI, all the above-mentioned parameters were higher as follows: sensitivity-91.18%; specificity-92.31%. CONCLUSIONS In patients with MFMCC, both CESM and MRI are highly sensitive in the detection of additional cancer foci. Both CESM and MRI change the extent of surgical intervention in every fourth patient.
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Affiliation(s)
- Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-514 Katowice, Poland;
| | - Michał Holecki
- Department of Internal, Autoimmune and Metabolic Diseases, Faculty of Medical Science, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Anna Barczyk-Gutkowska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Anna Grażyńska
- Students’ Scientific Society Department of Nuclear Medicine and Diagnostic Imaging, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, University Clinical Center Prof. K. Gibiński, 40-752 Katowice, Poland;
| | | | - Oskar Bożek
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Justyna Habas
- Faculty of Pharmaceutical Sciences, Medical University of Silesia in Sosnowiec, 41-200 Sosnowiec, Poland;
| | - Karol Szyluk
- I Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, 41-940 Piekary Śląskie, Poland;
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Iwona Gisterek
- Department of Oncology and Radiotherapy, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-515 Katowice, Poland;
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12
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Cui X, Jing X, Wu X, Xu J, Liu Z, Huo K, Wang H. Analyses of DNA Methylation Involved in the Activation of Nuclear Karyopherin Alpha 2 Leading to Identify the Progression and Prognostic Significance Across Human Breast Cancer. Cancer Manag Res 2020; 12:6665-6677. [PMID: 32801900 PMCID: PMC7416187 DOI: 10.2147/cmar.s261290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Karyopherin alpha 2 (KPNA2) is a nuclear import factor that plays a crucial role in nucleocytoplasmic transport, as well as cell proliferation, migration, and invasion in several cancers. However, the roles of KPNA2 in breast cancer as well as the underlying molecular mechanisms have not been elucidated. Materials and Methods To evaluate gene expression alterations during breast carcinogenesis, KPNA2 expression was analyzed using the Gene Expression Profiling Interactive Analysis and Oncomine analyses. The correlation between methylation and expression was analyzed using the MEXPRESS tool, UALCAN cancer database, and cBioPortal browser. Then, the expression and prognostic value of KPNA2 were investigated by our own breast cancer samples using RT-PCR. KPNA2 methylation level was detected by methylation-specific PCR. Results We obtained the following important results. (1) KPNA2 expression was significantly higher in breast cancer than normal samples and regulated by aberrant DNA hypomethylation of promoter region. (2) Among patients with breast cancer, those with higher KPNA2 expression had a lower survival rate. (3) The major mutation type of KPNA2 in breast cancer samples was missense mutation. (4) Homer1 was able to promote breast cancer progression may be through upregulating TPX2 expression. Conclusion Our findings suggest that aberrant DNA hypomethylation of promoter regions contributes to the aberrant expression of KPNA2 in breast cancer, which might be a potential indicator of poor prognosis.
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Affiliation(s)
- Xiangrong Cui
- Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Xuan Jing
- Clinical Laboratory, Shanxi Province People's Hospital, Affiliated of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Xueqing Wu
- Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Jing Xu
- Department of Hematology, 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, People's Republic of China
| | - Zhuang Liu
- Department of Hematology, 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, People's Republic of China
| | - Kai Huo
- Department of Breast Surgery, Shanxi Cancer Hospital, Taiyuan 030000, People's Republic of China
| | - Hongwei Wang
- Department of Hematology, 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, People's Republic of China
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13
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Zhao S, Zhang X, Zhong H, Qin Y, Li Y, Song B, Huang J, Yu J. Background Parenchymal Enhancement on Contrast-Enhanced Spectral Mammography: Influence of Age, Breast Density, Menstruation Status, and Menstrual Cycle Timing. Sci Rep 2020; 10:8608. [PMID: 32451404 PMCID: PMC7248100 DOI: 10.1038/s41598-020-65526-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/04/2020] [Indexed: 02/08/2023] Open
Abstract
To evaluate the relationship of the extent and quantitative intensity of background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM) with age, breast density, menstruation status, and menstrual cycle timing. This retrospective study included women who underwent CESM from July 2017 to March 2019 and who had menstruation status records. BPE category assessment was performed subjectively. BPE intensity was quantitatively measured using regions-of-interest. 208 subjects were included (150 were regular menstrual cycle and 58 were postmenopausal). The breast density was classified as category B in 11 subjects, category C in 231 subjects, and category D in 23 subjects. Subjects based on menstrual cycle timing, 24 at days 1-7, 55 at days 8-14, 48 at days 15-21, and 23 at days 22-28. Both quantitative and categorical analyses show a weak negative correlation between BPE and age in all subjects, but there was no significant correlation in premenopausal patients. Both the BPE pixel intensity value and BPE category was significantly lower in postmenopausal patients than in premenopausal patients, and there was no significant difference in breast density according to BPE. The minimum and maximum pixel values of BPE on days 8-14 of the menstrual cycle was significantly lower than those on days 15-21. There was no correlation between BPE level and menstrual cycle timing. Breast density with category D was more likely to have a lower BPE level than category C. We show here that BPE level is affected by menstruation status and menstrual cycle timing. We suggest that CESM should not be performed on days 15-21 of the menstrual cycle, but on days 8-14.
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Affiliation(s)
- Shuang Zhao
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xueqin Zhang
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Huanhuan Zhong
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yun Qin
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yan Li
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Juan Huang
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China.
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China.
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Qin Y, Liu Y, Zhang X, Zhao S, Zhong H, Huang J, Yu J. Contrast-enhanced spectral mammography: A potential exclusion diagnosis modality in dense breast patients. Cancer Med 2020; 9:2653-2659. [PMID: 32074407 PMCID: PMC7163102 DOI: 10.1002/cam4.2877] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 12/10/2019] [Accepted: 01/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND China has an increasing burden of breast cancer. However, with a large population of dense breast patients, the diagnostic efficiency of conventional digital mammography is attenuated. METHODS From July 2017 to October 2018, we retrospectively reviewed 397 dense breast patients who underwent contrast-enhanced spectral mammography (CESM) in West China Hospital. Among them, 53 patients who had both CESM and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) results and 114 patients who had pathological diagnoses were finally enrolled. All images were reviewed by two independent radiologists according to the 2013 Breast Imaging Reporting and Data System (BI-RADS) with all disagreements handed to an associate professor for final decisions. Correlation analyses between CESM and DCE-MRI were conducted. The diagnostic performance of CESM were investigated. RESULTS The kappa value of the BI-RADS scores between CESM and DCE-MRI was 0.607 (P < .001), indicating high correspondence between CESM and DCE-MRI. As for lesion size measurement, moderate correlation (Kendall's tau coefficient: 0.556, P < .001) was detected between CESM and DCE-MRI. Using pathological diagnoses as the reference standard, the sensitivity, specificity, and area under the curve (AUC) of CESM were 82.4%, 96.4%, and 0.894, respectively. CONCLUSION CESM demonstrated excellent overall diagnostic accuracy and a moderate correlation in lesion size estimation against DCE-MRI in dense breast patients, supporting it to be an alternative to DCE-MRI in breast cancer detection and diagnosis, especially for exclusion diagnosis.
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Affiliation(s)
- Yun Qin
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Ying Liu
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Xueqin Zhang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Shuang Zhao
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Huanhuan Zhong
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Juan Huang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Jianqun Yu
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
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