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Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis

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Abstract

Objective

To assess the utility of dual-energy contrast-enhanced spectral mammography (DE-CESM) for evaluation of suspicious malignant microcalcifications.

Methods

Two hundred and fifty-six DE-CESMs were reviewed from 2012–2013, 59 cases fulfilled the following criteria and were enrolled for analysis: (1) suspicious malignant microcalcifications (BI-RADS 4) on mammogram, (2) no related mass, (3) with pathological diagnoses. The microcalcification morphology and associated enhancement were reviewed to analyse the accuracy of the diagnosis and cancer size measurements versus the results of pathology.

Results

Of the 59 microcalcifications, 22 were diagnosed as cancers, 19 were atypical lesions and 18 were benign lesions. Twenty (76.9 %) cancers, three (11.55 %) atypia and three (11.55 %) benign lesions revealed enhancement. The true-positive rate of intermediate- and high-concern microcalcifications was significantly higher than that of low-concern lesions (93.75 % vs. 50 %). Overall, the diagnostic sensitivity of enhancement was 90.9 %, with 83.78 % specificity, 76.92 % positive predictive value, 93.94 % negative predictive value and 86.4 % accuracy. Performance was good (AUC = 0.87) according to a ROC curve and cancer size correlation with a mean difference of 0.05 cm on a Bland-Altman plot.

Conclusions

DE-CESM provides additional enhancement information for diagnosing breast microcalcifications and measuring cancer sizes with high correlation to surgicohistology.

Key Points

• DE-CESM provides additional enhancement information for diagnosing suspicious breast microcalcifications.

• The enhanced cancer size closely correlates to microscopy by Bland-Altman plot.

• DE-CESM could be considered for evaluation of suspicious malignant microcalcifications.

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Abbreviations

95 % CI:

95 % confidence interval

ACR:

America College of Radiology

ADH:

Atypical ductal hyperplasia

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

FEA:

Flat epithelial atypia

FN:

False negative

FP:

False positive

IDC:

Invasive ductal carcinoma

MLO:

Mediolateral oblique

MRI:

Magnetic resonance imaging

Mx:

Mammography

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

TN:

True negative

TP:

True positive

References

  1. Kettritz U, Rotter K, Schreer I et al (2004) Stereotactic vacuum-assisted breast biopsy in 2874 patients. Cancer 100:245–251

    Article  PubMed  Google Scholar 

  2. Liberman EA, Abramson AF, Squires FB, Glassman JR, Morris EA, Dershaw DD (1998) The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol 171:35–40

    Article  CAS  PubMed  Google Scholar 

  3. Orel SG, Kay N, Reynolds C, Sullivan DC (1999) BI-RADS categorization as a predictor of malignancy. Radiology 211:845–850

    Article  CAS  PubMed  Google Scholar 

  4. Burnside ES, Ochsner JE, Fowler KJ et al (2007) Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology 242:388–395

    Article  PubMed  Google Scholar 

  5. Bent CK, Bassett LW, D’Orsi CJ, Sayre JW (2010) The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories. AJR Am J Roentgenol 194:1378–1383

    Article  PubMed  Google Scholar 

  6. Kopans DB (2014) Digital breast tomosynthesis from concept to clinical care. AJR Am J Roentgenol 202:299–308

    Article  PubMed  Google Scholar 

  7. Michell MJ, Iqbal A, Wasan RK et al (2012) Comparison of accuracy of film-screen mammography, fill-field digital mammography, and digital breast tomosynthesis. Clin Radiol 67:976–981

    Article  CAS  PubMed  Google Scholar 

  8. Wallis MG, Moa E, Zanca F, Leifland K, Danielsson M (2012) Two-view and single-view tomosynthesis versus full-field digital mammography: high-resolution X-ray imaging observer study. Radiology 262:788–796

    Article  PubMed  Google Scholar 

  9. Dromain C, Thibault F, Diekmann F et al (2012) Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study. Breast Cancer Res 14:R94

    Article  PubMed  PubMed Central  Google Scholar 

  10. Diekmann F, Freyer M, Diekmann S et al (2011) Evaluation of contrast-enhanced digital mammography. Eur J Radiol 78:112–121

    Article  PubMed  Google Scholar 

  11. Cheung YC, Lin YC, Wan YL et al (2014) 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

    Article  PubMed  Google Scholar 

  12. Dromain C, Thibault F, Muller S et al (2011) Dual-energy contrast-enhanced digital mammography: initial clinical results. Eur Radiol 21:565–574

    Article  PubMed  Google Scholar 

  13. Jong RA, Yaffe MJ, Skarpathiotakis M et al (2003) Contrast-enhanced digital mammography: initial clinical experience. Radiology 228:842–850

    Article  PubMed  Google Scholar 

  14. Diekmann F, Diekmann S, Jeunehomme F et al (2005) Digital mammography using iodine-based contrast media: initial clinical experience with dynamic contrast medium enhancement. Investig Radiol 40:397–404

    Article  Google Scholar 

  15. Dromain C, Balleyguier C, Muller S et al (2006) Evaluation of tumor angiogenesis of breast carcinoma using contrast enhanced digital mammography. AJR Am J Roentgenol 187:W528–W537

    Article  PubMed  Google Scholar 

  16. Lewin JM, Isaacs PK, Vance V et al (2003) Dual-energy contrast-enhanced digital subtraction mammography: feasibility. Radiology 229:261–268

    Article  PubMed  Google Scholar 

  17. Jochelson MS, Dershaw DD, Sung JS et al (2013) Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast cancer. Radiology 266:743–751

    Article  PubMed  Google Scholar 

  18. Morris EA, Liberman L, Ballon DJ et al (2003) MRI of occult breast carcinoma in a high- risk population. AJR Am J Roentgenol 181:619–626

    Article  PubMed  Google Scholar 

  19. Berg WA (2003) Rationale for a trial of screening breast ultrasound: American College of Radiology Imaging Network (ACRIN) 6666. AJR Am J Roentgenol 180:1225–1228

    Article  PubMed  Google Scholar 

  20. Obenauer S, Hermann KP, Grabbe E (2005) Applications and literature review of the BI-RADS classification. Eur Radiol 15:1027–1036

    Article  CAS  PubMed  Google Scholar 

  21. Bazzocchi M, Zuiani C, Panizza P et al (2006) Contrast-enhanced breast MRI in patients with suspicious microcalcifications on mammography: results of a multicenter trial. AJR Am J Roentgenol 186:1723–1732

    Article  PubMed  Google Scholar 

  22. McGhan LJ, Wasif N, Gray RJ et al (2010) Use of preoperative magnetic resonance imaging for invasive lobular cancer: good, better, but maybe not the best? Ann Surg Oncol 17:255–262

    Article  PubMed  Google Scholar 

  23. Wasif N, Garreau J, Terando A, Kirsch D, Mund DF, Giuliano AE (2009) MRI versus ultrasonography and mammography for preoperative assessment of breast cancer. Am Surg 75:970–975

    PubMed  Google Scholar 

  24. Mann RM, Hoogeveen YL, Blickman JG, Boetes C (2008) MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat 107:1–14

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fallenberg EM, Dromain C, Diekmann F et al (2014) Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol 24:256–264

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Dr Yun-Chung Cheung. 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. The authors state that this work has not received any funding. A statistician did the analysis, but was not an author. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Study subjects or cohorts have not 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 at Tao Yuan and Linkuo, Medical College of Chang Gung University, 5 Fuxing Street, Guishan Township, Taoyuan County, Taiwan

    Yun-Chung Cheung & Pei-Chin Huang

  2. Department of Surgery, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan

    Hsiu-Pei Tsai, Yung-Feng Lo & Shin-Chih Chen

  3. Department of Pathology, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan

    Shir-Hwa Ueng

  4. Medical Collage of Chang Gung University, Taoyuan, Taiwan

    Yun-Chung Cheung, Hsiu-Pei Tsai, Yung-Feng Lo & Shin-Chih Chen

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  1. Yun-Chung Cheung
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  2. Hsiu-Pei Tsai
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Correspondence to Yun-Chung Cheung.

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Cheung, YC., Tsai, HP., Lo, YF. et al. Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis. Eur Radiol 26, 1082–1089 (2016). https://doi.org/10.1007/s00330-015-3904-z

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  • DOI: https://doi.org/10.1007/s00330-015-3904-z

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