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Preoperative loco-regional staging of invasive lobular carcinoma with contrast-enhanced digital mammography (CEDM)

  • BREAST RADIOLOGY
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Abstract

The aim of our study was to assess the performance of contrast-enhanced digital mammography (CEDM) in the preoperative loco-regional staging of invasive lobular carcinoma (ILC) patients, about the valuation of the extension of disease and in measurement of lesions. Then, we selected retrospectively, among the 1500 patients underwent to CEDM at the Breast Diagnostics Department of the Careggi University Hospital of Florence and the National Cancer Institute of Milan from September 2016 to November 2018, 31 women (mean age 57.1 aa; range 41–78 aa) with a definitive histological diagnosis of ILC. CEDM has proved to be a promising imaging technique, being characterized by a sensitivity of 100% in the detection of the index lesion, and of 84.2% in identifying any adjunctive lesions: It was the presence of a non-mass enhancement (NME) to lower the sensitivity of the technique (25% vs. 100% for mass-like enhancements or a mass closely associated with a NME). Specificity in the characterization of additional lesions was 66.7%, and the diagnosis of the extension of disease was correct in 77.4% of cases: NME also led to a decrease in diagnostic accuracy in the evaluation of disease extension up to 40% versus 85% for masses and 80% for masses associated with NME (M/NME). Moreover, in 12/31 (38.7%), CEDM allowed to correctly identify lesions not shown by mammography + ultrasonography + tomosynthesis: In the half of these (6/12), there was a multicentricity, thus allowing an adequate surgical planning change. CEDM was also very accurate in analyzing the maximum diameter of the masses, while it was much less reliable in the case of the M/NME and pure NME. In conclusion, CEDM is a new promising imaging technique in the loco-regional preoperative staging and in the evaluation of disease extension for ILC, especially in case of mass enhancement lesions.

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Authors and Affiliations

  1. Department of Radiology, University of Palermo, Palermo, Italy

    Francesco Amato & Tommaso Vincenzo Bartolotta

  2. Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy

    Giulia Bicchierai, Federica Di Naro, Ermanno Vanzi & Jacopo Nori

  3. General Management Staff, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Donatello Cirone

  4. Breast Imaging Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Catherine Depretto & Gianfranco Scaperrotta

  5. Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Vittorio Miele

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  1. Francesco Amato
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  2. Giulia Bicchierai
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Correspondence to Giulia Bicchierai.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee: “Regione Toscana, Comitato Etico Area Vasta Centro, reference number: SPE_16.251” and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Amato, F., Bicchierai, G., Cirone, D. et al. Preoperative loco-regional staging of invasive lobular carcinoma with contrast-enhanced digital mammography (CEDM). Radiol med 124, 1229–1237 (2019). https://doi.org/10.1007/s11547-019-01116-7

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