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Assessing the malignancy of suspicious breast microcalcifications: the role of contrast enhanced mammography

  • Breast Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To assess the role of contrast-enhanced mammography (CEM) in predicting the malignancy of breast calcifications.

Material and methods

We retrospectively evaluated patients with suspicious calcifications (BIRADS 4) who underwent CEM and stereotactic vacuum-assisted biopsy (VAB) at our institution. We assessed the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of CEM in predicting malignancy of microcalcifications with a 95% confidence interval; we performed an overall analysis and a subgroup analysis stratified into group A-low risk (BIRADS 4a) and group B-medium/high risk (BIRADS 4b–4c). We then evaluated the correlation between enhancement and tumour proliferation index (Ki-67) for all malignant lesions.

Results

Data from 182 patients with 184 lesions were collected. Overall the SE of CEM in predicting the malignancy of microcalcifications was 0.70, SP was 0.85, the PPV was 0.82, the NPV was 0.76 and AUC was 0.78. SE in group A was 0.89, SP was 0.89, PPV was 0.57, NPV was 0.98 and AUC was 0.75. SE in group B was 0.68, SP was 0.80, PPV was 0.87, NPV was 0.57 and AUC was 0.75. Among malignant microcalcifications that showed enhancement (N = 52), 61.5% had Ki-67 ≥ 20% and 38.5% had low Ki-67 values. Among the lesions that did not show enhancement (N = 22), 90.9% had Ki-67 < 20% and 9.1% showed high Ki-67 values 20%.

Conclusions

The absence of enhancement can be used as an indicative parameter for the absence of disease in cases of low-suspicious microcalcifications, but not in intermediate-high suspicious ones for which biopsy remains mandatory and can be used to distinguish indolent lesions from more aggressive neoplasms, with consequent reduction of overdiagnosis and overtreatment.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy

    Catherine Depretto, Elisa D’Ascoli, Gianmarco Della Pepa, Giovanni Irmici, Claudia De Berardinis, Daniela Ballerini, Alice Bonanomi, Eleonora Ancona, Claudio Ferranti & Gianfranco Paride Scaperrotta

Authors
  1. Catherine Depretto
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  2. Elisa D’Ascoli
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  3. Gianmarco Della Pepa
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  4. Giovanni Irmici
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Contributions

CD was responsible for the conception of the study. E. D’Ascoli evaluated the literature, collected data and wrote the first draft of the manuscript. GDP performed analysis and interpretation of results. DB, AB and EA collected data. CDB and GI evaluated the literature and contributed to the finalisation of the manuscript. CF and GPS provided expertise, mentorship and final revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Elisa D’Ascoli.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was approved by the institutional review board. All procedures performed in the studies involving human participants were in accordance with the ethical standards of the Institution “Fondazione IRCCS Istituto Nazionale dei Tumori” of Milan and with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Participants provided informed consent for publication of the images in Fig. 1 and 2.

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Depretto, C., D’Ascoli, E., Della Pepa, G. et al. Assessing the malignancy of suspicious breast microcalcifications: the role of contrast enhanced mammography. Radiol med (2024). https://doi.org/10.1007/s11547-024-01813-y

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