Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography

Ying Liu,Xueqin Zhang,Yun Qin,Juan Huang,Huanhuan Zhong,Shuang Zhao,Jianqun Yu

doi:10.1038/s41598-020-66501-z

Ying Liu, Xueqin Zhang + Show 5 more

Open Access

https://doi.org/10.1038/s41598-020-66501-z

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Abstract

CESM is an emerging digital mammography technology with a high breast cancer detection and a limited diagnostic specificity. In order to improve specificity, we quantitatively assessed enhancement intensity of breast lesions with different pathological types and hormonal receptor status and evaluated the consistency of enhancement patterns between CESM and DCE-MRI. A total of 145 lesions were enrolled, consisting of 43 malignant (17 non-infiltrating cancers and 26 infiltrating cancers) and 99 benign lesions. The diagnostic performance of enhancement intensity in the former positions was significantly higher than that in the latter positions (AUC: 0.834 vs. 0.755, p = 0.0008). Infiltrating cancers showed the highest enhancement intensity, while benign lesions the lowest (mean CNR1: 7.6% vs. 2.7%; median CNR1: 6.8% vs. 2.7%). Enhancement intensity of ER or PR positive group was weaker than negative group, while HER-2 positive group was stronger than negative group. 28 patients with 28 lesions performed both CESM and DCE-MRI examinations, showing a coincidence rate of 64.2% and moderate agreement (k = 0.515) between CESM and DCE-MRI. In conclusion, quantitative analysis of enhancement characteristics is feasible to the diagnosis practice on CESM.

Highlights

Contrast-enhanced spectral mammography (CESM), an emerging digital mammography technology, has been approved by the U.S FDA and put into clinical use in 2011
As for enhancement patterns, several published papers[4,13,15] claimed that the distribution of enhancement patterns between benign and malignant lesions was different, which was similar to time-intensity curve (TIC) on breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)
For patients who had undergone CESM, we followed the clinical diagnostic and treatment process for more than 6 months, 145 lesions in 131 female patients were included for analysis

Summary

Introduction

Contrast-enhanced spectral mammography (CESM), an emerging digital mammography technology, has been approved by the U.S FDA and put into clinical use in 2011. Given that a number of benign lesions can reveal enhancement on CESM8,11, researchers have focused on how to differentiate breast cancers from benign lesions and improve the diagnostic specificity. Previous studies[12,13,14] have proved the diagnostic performance of enhancement intensity for breast cancers and concluded that enhancement intensity of malignancies was usually stronger than that of benign lesions. As for enhancement patterns, several published papers[4,13,15] claimed that the distribution of enhancement patterns between benign and malignant lesions was different, which was similar to time-intensity curve (TIC) on breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). This study was aim to quantitatively assess enhancement intensity of breast lesions with different pathological types and hormonal receptor status on CESM and evaluate the consistency of enhancement patterns between CESM and DCE-MRI

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Results

Conclusion