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Diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM): a retrospective study involving 644 breast lesions

  • BREAST RADIOLOGY
  • Published:
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Abstract

Objective

To evaluate the diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM) in comparison with that of full-field digital mammography (FFDM), either alone or accompanied with breast ultrasound (BUS) in a large series of patients/breast lesions (n = 644).

Patients and methods

In this retrospective study, five radiologists evaluated the lesions by three imaging modalities: FFDM, FFDM + BUS, and CESM and compared the imaging to the gold standard (histopathology or clinical follow-up). Diagnostic performance parameters and receiver operating characteristic (ROC) curves of CESM were calculated and compared to those of FFDM or FFDM + BUS (McNemar’s test). Additionally, the reliability of tumor size measurement by CESM was compared with the histopathological measurement.

Results

The study included 218 benign and 426 malignant lesions. 85% of benign and 93% of malignant lesions were adequately identified using CESM. With respect to FFDM and FFDM + BUS, CESM significantly increased sensitivity to 93.2% (+ 10.7% and + 3.4%, respectively); specificity to 84.4% (+ 15.8% and + 1.7%, respectively); PPV to 92.3% (+ 26.8% and + 3.6%, respectively); NPV to 86.0% (+ 1.6% and + 1.8%, respectively); and accuracy to 90.2% (+ 15.8% and + 3.2%, respectively). In the ROC curves analyses, the comparison among the three AUC values was also statistically significant (p < 0.001). Good agreement between tumor diameters measured using CESM and histopathology was observed (Spearman’s rank correlation, r = 0.891, p < 0.0001), although this technique tended to produce an overestimation of the size (+ 7 mm).

Conclusions

CESM has high diagnostic accuracy and can be considered as a useful technique for the assessment of breast lesions.

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Authors and Affiliations

  1. Breast Imaging Section, Department of Radiology, Grupo Hospitalario San Roque, C/Dolores de la Rocha, 35001, Las Palmas de Gran Canaria, Spain

    María del Mar Travieso-Aja, Daniel Maldonado-Saluzzi, Pedro Naranjo-Santana, Claudia Fernández-Ruiz, Wilsa Severino-Rondón & Mario Rodríguez Rodríguez

  2. Breast Surgery Service, Insular and Maternal and Child Hospitals, Plaza Dr. Pasteur s/n, 35016, Las Palmas de Gran Canaria, Spain

    Víctor Vega Benítez

  3. Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe s/n, 35016, Las Palmas de Gran Canaria, Spain

    Octavio Pérez-Luzardo

  4. Spanish Biomedical Research Centre, Physiopathology of Obesity and Nutrition (CIBERObn), Madrid, Spain

    Octavio Pérez-Luzardo

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  1. María del Mar Travieso-Aja
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Correspondence to Octavio Pérez-Luzardo.

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Travieso-Aja, M.M., Maldonado-Saluzzi, D., Naranjo-Santana, P. et al. Diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM): a retrospective study involving 644 breast lesions. Radiol med 124, 1006–1017 (2019). https://doi.org/10.1007/s11547-019-01056-2

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