Abstract
ObjectiveTo develop a risk predictor model in evaluation of tomosynthesis-detected architectural distortion (AD) based on characteristics of contrast-enhanced digital mammography (CEDM).MethodsNinety-four AD lesions on CEDM in combination with tomosynthesis were retrospectively reviewed from 92 consecutive women (mean age, 52.4 years ± 7.9) with abnormal diagnostic or screening mammography. CEDM results were correlated with histology of ADs using cross-tabulation for statistical analysis. Predictors for risk of malignancy from CEDM characteristics (background parenchyma enhancement, degree of AD enhancement, enhancing morphology, size of enhancement, and enhancing spiculations) and patient’s age were evaluated using logistic regression. We propose a sum score, termed AD score (ADS), for risk stratification and corresponding suggested BI-RADS category.ResultsThirty-three of ninety-four (35.1%) of detected AD lesions were malignant. The sensitivity, specificity, PPV, and NPV of CEDM in evaluation of malignant AD are 100%, 42.6%, 48.5%, and 100%, respectively. Absence of AD enhancement on CEDM is highly indicative of no underlying malignancy. On multivariate analysis, the predictors on CEDM with statistical significance are (1) marked intensity of AD enhancement (OR, 22.6; 95%CI 3.1, 166.6; p = .002); and (2) presence of enhancing spiculations (OR, 9.1; 95%CI 2.2, 36.5; p = .002). A prediction model whose scores (ADS) given by ranking of OR of all predictors with AUC of 0.934 and Brier score of 0.0956 was developed.ConclusionADS-based lesion characterization on CEDM enables risk assessment of tomosynthesis-detected AD lesions.Key Points• Architecture distortions presenting with marked enhancement intensity and presence of enhancing spiculations are highly associated with risk of malignancy.• Absence of architecture distortion enhancement in minimal or mild background parenchyma enhancement on CEDM indicates low risk of breast malignancy (NPV = 100%).
Highlights
Introduction support its useAs far as we know, there is only a single study published to date and the sample size was small [17].this study, with a larger sample size is designed to investigate the diagnostic capabilities of contrast-enhanced digital mammography (CEDM) in the evaluation of architectural distortion (AD) detected on digital breast tomosynthesis (DBT), in the hope to potentially reduce the number and need for biopsy or surgical excision in patients with benign causes of AD
This study, with a larger sample size is designed to investigate the diagnostic capabilities of CEDM in the evaluation of AD detected on DBT, in the hope to potentially reduce the number and need for biopsy or surgical excision in patients with benign causes of AD
We aim to develop a practical scoring model to stratify the malignant risk of AD on CEDM based on each imaging characteristic
Summary
This study, with a larger sample size is designed to investigate the diagnostic capabilities of CEDM in the evaluation of AD detected on DBT, in the hope to potentially reduce the number and need for biopsy or surgical excision in patients with benign causes of AD. In the absence of a non-invasive modality to accurately differentiate between benign and malignant causes of AD, an invasive procedure such as biopsy or surgical excision is often required. This poses a diagnostic and management challenge to breast radiologists and surgeons. This issue is expected to worsen due to the increased detection of AD from the growing clinical use of digital breast tomosynthesis (DBT) [6,7,8]
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