Added value of contrast-enhanced spectral mammogram in assessment of suspicious microcalcification and grading of DCIS

Amr Farouk Ibrahim Moustafa,Ola Magdy Mohamed Shetat,Mohamed Ibrahim Ibrahim Fahim,Ghada Mohamed,Mohammed Mohammed Gomaa,Sara Zaitoon

doi:10.1186/s43055-021-00554-6

Amr Farouk Ibrahim Moustafa, Ola Magdy Mohamed Shetat + Show 4 more

Open Access

https://doi.org/10.1186/s43055-021-00554-6

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Abstract

BackgroundBreast microcalcifications are one of the most difficult mammographic findings to assess. The purpose of this study is to assess the ability of contrast-enhanced spectral mammography in the assessment of suspicious microcalcification and in predicting the grade of DCIS.MethodsThree hundred and forty cases with suspicious microcalcification were reviewed in this study. We excluded 160 cases associated with masses. We enrolled 180 cases for analysis of suspicious microcalcification on mammograms with no underlying masses. We reviewed the microcalcification for their morphology, distribution, and associated pathological enhancement according to BI-RADS lexicon with pathology results reviewed and classified into benign and malignant which subdivided into low, intermediate, or high-grade DCIS or invasive carcinoma.ResultsThree hundred and forty cases with suspicious microcalcification were reviewed in this study. We excluded 160 cases associated with masses. Forty-five of 180 cases were benign, and 135/180 cases were malignant. Twenty-five of 135 cases were diagnosed as invasive breast carcinomas while 110/135 were ductal carcinoma in situ. From the latter, 110 patients with DCIS, 22/110 cases were low grade, 11/110 cases were intermediate grade, and 77/110 cases were high grade (44 with micro-invasion). A total of 25 invasive carcinomas showed pathological non-mass enhancement, 76/77 cases of high-grade DCIS, and 6/11 cases of intermediate-grade DCIS. No abnormal enhancement appeared with benign entities, low-grade DCIS, and 5/11 cases of intermediate DCIS. The diagnostic performance of CESM in anticipation of high grade in DCIS patients was sensitivity of 98%, specificity of 81.8%, and accuracy of 93.1%. CESM sensitivity, specificity, and accuracy in prediction of invasiveness or high-grade DCIS were 98.5%, 81.8%, and 87.5%, respectively.ConclusionCESM can provide a fundamental contribution in the evaluation of suspicious microcalcification as high-grade DCIS or invasive component can present by non-mass enhancement, but enhancement paucity is favorable to diagnose benign lesion or non-invasive/low-grade DCIS.

Highlights

Breast microcalcifications are one of the most difficult mammographic findings to assess
This study aims to assess the ability of Contrast-enhanced spectral mammography (CESM) in the assessment of suspicious microcalcification and in predicting the grade of Ductal carcinoma in situ (DCIS)
Diagnostic performance of CESM in the prediction of high grade in DCIS patients was sensitivity of 98%, specificity of 81.8%, and accuracy of 93.1%

Summary

Introduction

Breast microcalcifications are one of the most difficult mammographic findings to assess. The purpose of this study is to assess the ability of contrast-enhanced spectral mammography in the assessment of suspicious microcalcification and in predicting the grade of DCIS. Breast calcifications are one of the common mammographic findings in screening and symptomatic populations. An approach to discriminate between benign and malignant breast calcifications to image analysis includes morphology, distribution, size, stability, and the number of calcifications [1]. Suspicious grouped calcifications can occur in ductal carcinoma in situ [1]. The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) classifies calcifications on mammograms into three categories: typical benign, intermediate concern, and higher probability of malignancy [1,2,3].

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