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OBJECTIVE: To compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) versus ultrasonography (US) in symptomatic patients with dense breasts, while using histology as the gold standard.MATERIALS AND METHODS: After obtaining approval from the local ethics board, this prospective study collected data from patients with symptomatic breasts who underwent CESM and US examinations from May 1, 2017 to September 30, 2017. We then selected those with dense breasts and pathological results as our sample population. Both CESM and US results were classified by a radiologist through the Breast Imaging Reporting and Data System, and the results were compared with their corresponding histological results. The chi-square test was conducted to compare the diagnostic performance of CESM and US, and the receiver operating characteristic curves for the two imaging modalities were obtained.RESULTS: A total of 131 lesions from 115 patients with dense breasts were included in this study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 93.8%, 88.1%, 88.2%, 93.7%, and 90.8% for CESM, and 90.6%, 82.1%, 82.9%, 90.2%, and 86.3% for US, respectively. The p values for sensitivity, specificity, PPV, NPV, and accuracy were 0.687, 0.388, 0.370, 0.702, and 0.238, respectively. The area under the curve of CESM (0.917) was comparable with that of US (0.884); however, the differences between CESM and US were not statistically significant (p = 0.225). Eight false-positive cases and 4 false-negative cases for breast cancer were found in CESM, while 12 false-positive cases and 6 false-negative cases were found in US.CONCLUSION: The diagnostic performances of CESM and US are comparable in symptomatic women with dense breasts; however, the routine use of additional US imaging is questionable for lesions that can be detected by CESM.
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Objective To assess the contribution of contrast-enhanced spectral mammography (CESM) in detecting breast carcinoma of dense breasts. Methods To retrospectively analyze the imaging and clinical data of 52 female patients with breast carcinoma which were confirmed by pathology in Tai'an Central Hospital of Shandong Province from April 2017 to April 2018.All cases classified as dense or uneven dense breasts by DM examination underwent Ultrasound (US), digital mammography (DM), CESM, dynamic contrast enhanced MRI (DCE-MRI).The breast imaging report and data system (BI-RADS) and breast density classification were both evaluated using the 5th edition of BI-RADS. The efficacy of US, DM, DM+CESM, DCE-MRI in detecting breast carcinoma (BI-RADS 5) was evaluated by χ2 test. Results Histopathology confirmed that 87 lesions were malignant and 35 lesions were benign. The sensitivity of US, DM, DM +CESM, DCE-MRI were 66.67％(58/87), 64.37％(56/87), 100.00％(87/87), 100.00％(87/87) and the specificity were 94.28％(33/35), 74.28％(26/35), 85.71％(30/35), 51.43％(18/35), respectively. There was statistically significant difference in specificity (χ2=9.545, P=0.002) and BI-RADS 5 category, detection 39.08％(34/87), 22.99％(20/87), respectively (χ2=5.263, P=0.022) between the DM + CESM group and DCE-MRI group. Conclusion In dense breasts, CESM has a high application value in breast carcinoma diagnosis.
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Objective@#To assess the diagnostic performance of contrast-enhanced spectral mammography (CESM) in suspected breast lesions.@*Methods@#A total of 97 patients with suspected breast cancer identified by clinical examination or screening underwent two-views CESM examination on the basis of digital breast tomosynthesis (DBT) combined with full-field digital mammography (FFDM), and they were finally confirmed by biopsy or pathology. Three senior radiologists analyzed images, including lesion visibility, lesion characteristics, enhancement type, degree of enhancement, BIRDS classification, etc. Finally, based on the pathology, we compared the CESM+DBT+FFDM and DBT+FFDM two models according to sensitivity, specificity and ROC for diagnostic performance.@*Results@#There were a total of 120 lesions. Eighty-nine lesions were malignant, 31 benign; CESM was not enhanced in 2 cases, mild enhancement was performed in 22 cases, moderately intensive in 15 cases, highly intensive in 81 cases, and 2 cases were not enhanced; mass-enhanced in 96 cases, including ring-enhanced in 12 cases, 22 cases of non-mass type. The sensitivities of the combination of CESM and not combination of CESM were 91.0% and 80.9%, respectively, and the specificities were 93.5% and 87.1%, respectively. The area under the ROC curve of combination of CESM was higher than the without combination of CESM (0.923 and 0.900, P<0.05), The difference was statistically significant.@*Conclusion@#For suspicious lesions, CESM examination can improve the diagnosis accuracy of breast cancer.
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Objective: To observe the diagnostic efficacy of contrast-enhanced spectral mammography (CESM) and MRI for breast cancers using meta-analysis. Methods: Literature of CESM and MRI in diagnosis of breast lesions were extracted in the databases, including CNKI, CBM, Cochrane Library, Web of Science and other domestic and foreign databases in recent 10 years. The software Review Manager 5.3 was used to evaluate the publication quality assessment according the quality assessment of diagnostic accuracy studies-2 (QUADAS-2). After testing the heterogeneity of enrolled literatures using Meta Disc 1.4, the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) for diagnosis of breast cancers of these two methods were summarized, and the diagnostic experiment Deek's funnel chart was drawn to evaluate the publication bias and authenticity. Results: A total of 661 papers were searched, and 12 were enrolled. The summarized results showed the sensitivity of CESM and MRI were both 0.97, the specificity was 0.69 and 0.51, the DOR was 105.44 and 33.73, PLR was 2.94 and 1.95, NLR was 0.05 and 0.07, and the AUC (95%CI) was 0.964 5 (0.955 8, 0.981 5) and 0.919 8 (0.892 7, 0.946 8), respectively. AUC of CESM was larger than that of MRI. Deek's funnel plot showed that the publication bias was not significant (P>0.05). Conclusion: CEMS is a valuable diagnostic method for breast cancers which has certain advantages in some aspects compared with MRI.
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Objective To assess the diagnostic performance of contrast-enhanced spectral mammography (CESM) in suspected breast lesions. Methods A total of 97 patients with suspected breast cancer identified by clinical examination or screening underwent two-views CESM examination on the basis of digital breast tomosynthesis (DBT) combined with full-field digital mammography (FFDM), and they were finally confirmed by biopsy or pathology. Three senior radiologists analyzed images, including lesion visibility, lesion characteristics, enhancement type, degree of enhancement, BIRDS classification, etc. Finally, based on the pathology, we compared the CESM+DBT+FFDM and DBT+FFDM two models according to sensitivity, specificity and ROC for diagnostic performance. Results There were a total of 120 lesions. Eighty-nine lesions were malignant, 31 benign; CESM was not enhanced in 2 cases, mild enhancement was performed in 22 cases, moderately intensive in 15 cases, highly intensive in 81 cases, and 2 cases were not enhanced; mass-enhanced in 96 cases, including ring-enhanced in 12 cases, 22 cases of non-mass type. The sensitivities of the combination of CESM and not combination of CESM were 91.0% and 80.9%, respectively, and the specificities were 93.5% and 87.1%, respectively. The area under the ROC curve of combination of CESM was higher than the without combination of CESM (0.923 and 0.900, P<0.05), The difference was statistically significant. Conclusion For suspicious lesions, CESM examination can improve the diagnosis accuracy of breast cancer.
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Objective To assess the value of contrast enhanced mammography (CESM) in the detection of breast cancer. Methods A total of 145 patients who were suspected of breast abnormalities by clinical examination or ultrasound were prospectively collected. All patients underwent bilateral breast CESM and MRI examinations. Breast CESM and MRI examination were completed in the same week. The pathological specimens were analyzed and the maximum diameters of pathological lesions were measured. The lesions were observed on low energy(LE), CESM and MRI images, and then the maximum diameters of lesions on the above images were measured. Using pathology results as the gold standard, the diagnostic efficacy of LE, CESM and MRI were analyzed by ROC curve, and Z test was used to compare the areas under the ROC curves among different imaging methods. Bland-Altman method was used to analyze the consistency of the maximum diameters of the lesions obtained with different imaging methods. Results One hundred and fifty three lesions were found in 145 patients, in which 36 were benign and 117 were malignant. The LE, CESM and MRI showed 140, 151 and 149 lesions respectively, and the qualitative diagnostic errors were 25, 8 and 11, respectively. The areas under ROC curves of LE, CESM and MRI were 0.87, 0.96 and 0.97 respectively. There was significant difference of the area under ROC curve between CESM and LE, so did the MRI and LE (P<0.05), but there was not significant difference between CESM and MRI (P=0.51). The sensitivity, specificity and accuracy in the diagnosis of malignant breast lesions were 88.98%, 65.71% and 83.66% for LE, while they were 95.80%, 91.18% and 94.77% for CESM, 94.17%, 87.88%and 92.81%for MRI. The average difference of diameters between LE, CESM, MRI and pathologic size was-1.7, 1.1 and 0.3 mm, respectively, with 95%consistency interval range of-18.6 to 15.1,-9.8 to 12.1,-10.6 to 11.2 mm, respectively. There was best consistency between the pathological size and the size on MRI. Conclusion CESM can significantly improve the diagnostic efficacy of breast lesions, which is comparable with MRI.
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OBJECTIVE: The goal of the study was to compare conventional mammography (MG) and contrast-enhanced spectral mammography (CESM) in preoperative women. MATERIALS AND METHODS: The study was approved by the local Ethics Committee and all participants provided informed consent. The study included 152 consecutive patients with 173 breast lesions diagnosed on MG or CESM. All MG examinations and consults were conducted in one oncology centre. Non-ionic contrast agent, at a total dose of 1.5 mL/kg body weight, was injected intravenous. Subsequently, CESM exams were performed with a mammography device, allowing dual-energy acquisitions. The entire procedure was done within the oncology centre. Images from low and high energy exposures were processed together and the combination provided an "iodine" image which outlined contrast up-take in the breast. RESULTS: MG detected 157 lesions in 150 patients, including 92 infiltrating cancers, 12 non-infiltrating cancers, and 53 benign lesions. CESM detected 149 lesions in 128 patients, including 101 infiltrating cancers, 13 non-infiltrating cancers, and 35 benign lesions. CESM sensitivity was 100% (vs. 91% for MG), specificity was 41% (vs. 15% for MG), area under the receiver operating characteristic curve was 0.86 (vs. 0.67 for MG), and accuracy was 80% (vs. 65% for MG) for the diagnosis of breast cancer. Both MG and CESM overestimated lesion sizes compared to histopathology (p < 0.001). CONCLUSION: CESM may provide higher sensitivity for breast cancer detection and greater diagnostic accuracy than conventional mammography.