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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

  • Breast
  • Published:
European Radiology Aims and scope Submit manuscript

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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Abbreviations

BI-RADS:

Breast Imaging Reporting and Data System

CC:

Craniocaudal

CEM:

Contrast-enhanced mammography

DCIS:

Ductal carcinoma in situ

LEI:

Low-energy image

MLO:

Mediolateral oblique

MRI:

Magnetic resonance imaging

NME:

Non-mass enhancement

RCI:

Recombined image

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Acknowledgements

Thanks to all participants in this study.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People’s Republic of China

    Liping Wang, Ping Wang, Huafei Shao & Qinglin Yang

  2. Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264100, Shandong, People’s Republic of China

    Jun Li

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  1. Liping Wang
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Correspondence to Qinglin Yang.

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The scientific guarantor of this publication is Qinglin Yang.

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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.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

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Liping Wang, Ping Wang, and Huafei Shao are co-first authors on the paper.

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Wang, L., Wang, P., Shao, H. et al. 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 (2023). https://doi.org/10.1007/s00330-023-10312-z

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  • DOI: https://doi.org/10.1007/s00330-023-10312-z

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