ABSTRACT
OBJECTIVE: To determine the usefulness of BI-RADS® MRI for the morphological description and categorization of images obtained with contrast-enhanced digital mammography in comparison with the final diagnosis. MATERIAL AND METHODS: We included patients who had palpable breast lesions, those who needed clarification regarding abnormalities identified with another imaging technique, and those which needed a complementary evaluation of heterogeneously dense breast parenchyma. Three radiologists working independently used a template with the BI-RADS® MRI qualitative descriptors to evaluate the breast lesions studied with contrast-enhanced digital mammography. In a second phase, two other experienced radiologists reached a consensus about discrepant interpretations. Readers also classified each lesion (both benign and malignant lesions) on the BI-RADS® scale (1 - 5). All the results were compared with the real state of disease (determined by the appropriate gold standard for each type of lesion), and the statistical significance was assessed with the chi-square test. RESULTS: A total of 218 benign lesions and 426 malignant lesions were included. The interobserver agreement among the three radiologists was high (Fleiss-Cohen kappa=0.805; 95% CI: 0.728-0.837). Similarly to what has been reported about breast MRI, on contrast-enhanced digital mammography, malignant lesions with mass effect tended to have an irregular shape with spiculated or ill-defined margins and a pattern of intense and heterogeneous enhancement (p <0.001). Nevertheless, unlike on breast MRI, ring enhancement was not an independent criterion of malignancy on contrast-enhanced digital mammography. For lesions without a mass effect, the only significant descriptor was the intensity of contrast material uptake (p <0.05). Applying the BI-RADS® MRI material to contrast-enhanced digital mammography images enabled the correct classification of 85% of lesions in the benign categories (BI-RADS 1 and BI-RADS 2 and 3 lesions) and of 93% of the lesions in the malignant categories (BI-RADS 4-5); these values are similar to those reported for breast MRI. CONCLUSIONS: The morphological descriptors used in BI-RADS® MRI can be applied to the morphological analysis of breast lesions studied with contrast-enhanced digital mammography. The partial discrepancies in the interpretation did not influence the final BI-RADS® score, and the score enabled good differentiation between benign and malignant lesions.
Subject(s)
Breast Diseases/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Mammography , Adult , Aged , Aged, 80 and over , Contrast Media , Female , Humans , Mammography/methods , Middle Aged , Radiographic Image EnhancementABSTRACT
Es bien conocido que el grado de vascularización de las lesiones mamarias se relaciona con su malignidad. Por ello, las técnicas de diagnóstico por imagen que estudian funcionalmente las lesiones han cobrado mucha relevancia en los últimos años. La mamografía con medio de contraste y energía dual es una técnica de reciente aparición, aparentemente prometedora en el cáncer de mama, que informa del grado de vascularización de la lesión junto con la información morfológica habitual. El propósito de este artículo es presentar el estado actual de esta nueva técnica de imagen. Basándonos en una experiencia de 15 meses, ilustramos esta revisión con casos clínicos que nos permiten presentar también sus ventajas y limitaciones (AU)
The degree of vascularization in breast lesions is related to their malignancy. For this reason, functional diagnostic imaging techniques have become important in recent years. Dual-energy contrast-enhanced mammography is a new, apparently promising technique in breast cancer that provides information about the degree of vascularization of the lesion in addition to the morphological information provided by conventional mammography. This article describes the state of the art for dual-energy contrast-enhanced mammography. Based on 15 months clinical experience, we illustrate this review with clinical cases that allow us to discuss the advantages and limitations of this technique (AU)
Subject(s)
Humans , Female , Contrast Sensitivity/radiation effects , Contrast Media , Mammography/methods , Mammography , Breast Neoplasms/diagnosis , Breast Neoplasms , Mammography/instrumentation , Spectrum Analysis/trends , Dose-Response Relationship, Radiation , Carcinoma, Intraductal, Noninfiltrating , Neoadjuvant Therapy/methodsABSTRACT
The degree of vascularization in breast lesions is related to their malignancy. For this reason, functional diagnostic imaging techniques have become important in recent years. Dual-energy contrast-enhanced mammography is a new, apparently promising technique in breast cancer that provides information about the degree of vascularization of the lesion in addition to the morphological information provided by conventional mammography. This article describes the state of the art for dual-energy contrast-enhanced mammography. Based on 15 months' clinical experience, we illustrate this review with clinical cases that allow us to discuss the advantages and limitations of this technique.
