Abstract
PurposeTo compare the efficacy of contrast-enhanced spectral mammography, with ultrasound, full field digital mammography and magnetic resonance imaging in detection and size estimation of histologically proven breast tumors.MethodsThis open-label, single center, prospective study, included 160 dense breast women with at least one suspicious mammary lesion evaluated by ultrasound, full field digital mammography and magnetic resonance imaging in whom a mammary tumor was histologically proven after surgery performed at the European Institute of Oncology between January 2013 and December 2015. Following the complete diagnostic procedure, the patients were further investigated by contrast-enhanced spectral mammography prior to surgery.ResultsOverall, the detection rate of malignant breast lesions (in situ and invasive) was 93.8% (165/176) for contrast-enhanced spectral mammography, 94.4% (168/178) for ultrasound, 85.5 (147/172) for full field digital mammography and 97.7% (173/177) for magnetic resonance imaging. Radiological measurements were concordant with the post-surgical pathological measurements of the invasive tumor (i.e., within 5 mm) in: 64.6% for contrast-enhanced spectral mammography, 62.0% for ultrasound, 45.2% for full field digital mammography (p < 0.0001) and 69.9% for magnetic resonance imaging (p = 0.28); underestimated in: 17.4% for contrast-enhanced spectral mammography, 19.6% for ultrasound, 24.2% for full field digital mammography (p = 0.03) and 6.7% for magnetic resonance imaging (p = 0.0005); and overestimated in: 16.2% for contrast-enhanced spectral mammography, 16.6% for ultrasound, 16.6% for full field digital mammography and 22.7% for magnetic resonance imaging (p = 0.02).ConclusionsOur data suggest that contrast-enhanced spectral mammography improves on full field digital mammography and is comparable to ultrasound and magnetic resonance imaging in terms of detection sensitivity and size estimation of malignant lesions in dense breasts.
Highlights
Contrast-enhanced spectral mammography (CESM) is a recently developed imaging technique relying on visualization of iodinated contrast agent uptake, proposed as a new complementary approach to breast imaging [1, 2]
These patients were characterized as having dense breasts (ACR 3 and 4 on full field digital mammography (FFDM)), and presented at least one suspicious mammary lesion evaluated by US, FFDM and MRI, subsequently confirmed as a malignant lesion at histo-pathological evaluation of the surgical specimen
In the evaluation of the relationship between detection rate and size estimation efficacy of each technique, in respect to the traditional pathological characteristics, the detection rate was influenced by the confound variables only in the case of FFDM, where the prevalence of missed lesions significantly increased in smaller and better differentiated (G1, 17.9%; G2, 20.0%; G3, 3.7%) tumors
Summary
Contrast-enhanced spectral mammography (CESM) is a recently developed imaging technique relying on visualization of iodinated contrast agent uptake, proposed as a new complementary approach to breast imaging [1, 2]. Breast cancer (BC) diagnosis and staging rely mainly on three diagnostic techniques: full field digital mammography (FFDM), ultrasound (US), mammography and magnetic. Breast Cancer Research and Treatment (2020) 184:723–731 resonance imaging (MRI). FFDM is best suited to studying breast tissue with a predominantly adipose component [1, 2] as its lower sensitivity in dense, fibro-glandular breasts may lead to increased false negative rates and cancer size underestimation, especially in young patients [3, 4]. US, on the other hand, is suitable for studying dense breasts, but its overall diagnostic efficacy is affected by the high false positive rate [3]. MRI is characterized by high sensitivity, independent of breast density, but its specificity is limited by high (up to 19%) false positive rates [5]. Evidence suggests that MRI is associated with treatment delay without an associated improvement in margin clearance at surgery and clinical outcome [6]
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