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Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis

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Abstract

Purpose

To analyse the accuracy of dual-energy contrast-enhanced spectral mammography in dense breasts in comparison with contrast-enhanced subtracted mammography (CESM) and conventional mammography (Mx).

Materials and methods

CESM cases of dense breasts with histological proof were evaluated in the present study. Four radiologists with varying experience in mammography interpretation blindly read Mx first, followed by CESM. The diagnostic profiles, consistency and learning curve were analysed statistically.

Results

One hundred lesions (28 benign and 72 breast malignancies) in 89 females were analysed. Use of CESM improved the cancer diagnosis by 21.2 % in sensitivity (71.5 % to 92.7 %), by 16.1 % in specificity (51.8 % to 67.9 %) and by 19.8 % in accuracy (65.9 % to 85.8 %) compared with Mx. The interobserver diagnostic consistency was markedly higher using CESM than using Mx alone (0.6235 vs. 0.3869 using the kappa ratio). The probability of a correct prediction was elevated from 80 % to 90 % after 75 consecutive case readings.

Conclusion

CESM provided additional information with consistent improvement of the cancer diagnosis in dense breasts compared to Mx alone. The prediction of the diagnosis could be improved by the interpretation of a significant number of cases in the presence of 6 % benign contrast enhancement in this study.

Key Points

• DE-CESM improves the cancer diagnosis in dense breasts compared with mammography.

• DE-CESM shows greater consistency than mammography alone by interobserver blind reading.

• Diagnostic improvement of DE-CESM is independent of the mammographic reading experience.

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Abbreviations

ACR:

American College of Radiology

BI-RADS:

Breast Imaging Reporting and Data System

CC:

craniocaudal

CESM:

contrast-enhanced subtracted mammography

DCIS:

ductal carcinoma in situ

DE-CESM:

dual-energy contrast-enhanced spectral mammography

GEE:

generalised estimating equation

IDC:

invasive ductal carcinoma

ILC:

invasive lobular carcinoma

MLO:

mediolateral oblique

Mo:

molybdenum

MRI:

magnetic resonance imaging

Mx:

mammography

NPV:

negative predictive value

PPV:

positive predictive value

Rh:

rhodium

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Acknowledgement

We would like to thank Yu-Jr Lin, MB for the statistical analysis. The work was supported by the grants from the Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital (CLRPG340599).

The scientific guarantor of this publication is Dr Yun-Chung Cheung who is the director of department.

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. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Approval from the institutional animal care committee was not required because this is a retrospective clinical review on humans. No subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkuo/TaoYuan, Taiwan

    Yun-Chung Cheung, Yu-Ching Lin, Yung-Liang Wan, Kee-Min Yeow & Pei-Chin Huang

  2. Medical College, Chang Gung Memorial Hospital, Linkuo/TaoYuan, Taiwan

    Yun-Chung Cheung, Yung-Liang Wan, Kee-Min Yeow, Yung-Feng Lo, Hsiu-Pei Tsai & Chee-Jen Chang

  3. Department of Surgery, Chang Gung Memorial Hospital, Linkuo/TaoYuan, Taiwan

    Yung-Feng Lo & Hsiu-Pei Tsai

  4. Department of Pathology, Chang Gung Memorial Hospital, Linkuo/TaoYuan, Taiwan

    Shir-Hwa Ueng

  5. Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkuo/TaoYuan, Taiwan

    Chee-Jen Chang

  6. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital (Linkuo/TaoYuan Branches), Medical College of Chang Gung University, No 123, Dinghu Road, Guishan Township, TaoYuan County, 333, Taiwan

    Yun-Chung Cheung

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  1. Yun-Chung Cheung
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Correspondence to Yun-Chung Cheung.

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Cheung, YC., Lin, YC., Wan, YL. et al. Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis. Eur Radiol 24, 2394–2403 (2014). https://doi.org/10.1007/s00330-014-3271-1

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  • DOI: https://doi.org/10.1007/s00330-014-3271-1

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