Radiomics of contrast-enhanced spectral mammography for prediction of pathological complete response to neoadjuvant chemotherapy in breast cancer

Comparative Evaluation of Contrast-Enhanced Spectral Mammography and Digital Breast Tomosynthesis for Diagnosing and Treating Breast Cancer

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.