Abstract
Contrast-enhanced spectral mammography (CESM) is a promising, digital breast imaging method for planning surgeries. The study aimed at comparing digital mammography (MG) with CESM as predictive factors in visualizing multifocal-multicentric cancers (MFMCC) before determining the surgery extent. We analyzed 999 patients after breast cancer surgery to compare MG and CESM in terms of detecting MFMCC. Moreover, these procedures were assessed for their conformity with postoperative histopathology (HP), calculating their sensitivity and specificity. The question was which histopathological types of breast cancer were more frequently characterized by multifocality–multicentrality in comparable techniques as regards the general number of HP-identified cancers. The analysis involved the frequency of post-CESM changes in the extent of planned surgeries. In the present study, MG revealed 48 (4.80%) while CESM 170 (17.02%) MFMCC lesions, subsequently confirmed in HP. MG had MFMCC detecting sensitivity of 38.51%, specificity 99.01%, PPV (positive predictive value) 85.71%, and NPV (negative predictive value) 84.52%. The respective values for CESM were 87.63%, 94.90%, 80.57% and 96.95%. Moreover, no statistically significant differences were found between lobular and NST cancers (27.78% vs. 21.24%) regarding MFMCC. A treatment change was required by 20.00% of the patients from breast-conserving to mastectomy, upon visualizing MFMCC in CESM. In conclusion, mammography offers insufficient diagnostic sensitivity for detecting additional cancer foci. The high diagnostic sensitivity of CESM effectively assesses breast cancer multifocality/multicentrality and significantly changes the extent of planned surgeries. The multifocality/multicentrality concerned carcinoma, lobular and invasive carcinoma of no special type (NST) cancers with similar incidence rates, which requires further confirmation.
Highlights
Breast cancer has the highest incidence rate of all cancers in women both in Poland and worldwide [1,2]
The HP results were adopted as a reference method and the level of compliance was examined between this method and the results obtained in mammography (MG) and Contrast-enhanced spectral mammography (CESM) (Table 2)
The analysis focused on the number of changes in the scope of conserving therapy into different types of mastectomy upon identification of multifocal-multicentric cancers (MFMCC) in CESM (Table 5)
Summary
Breast cancer has the highest incidence rate of all cancers in women both in Poland and worldwide [1,2]. The choice between the surgical and systemic treatment method for breast cancer depends on the histological type and grading of carcinoma, the ER/PgR and Ki67 expression and the HER2 status, as well as on progression of the primary tumor and the axillary lymph nodes, the presence and extent of metastases in distant organs, the menopausal status, the age, physical condition, past, and concomitant diseases and the related treatment, as well as the patient’s preferences [3,4]. The choice between breast-conserving surgical treatment and mastectomy is, to a large extent, dependent on the size of the tumor and exclusion of the multifocality and multicentrality of cancer lesions [5,6]. Exploring the impact of additional neoplastic foci in the breast on the scope of surgical treatment for the present study, multifocal and multicentric cancers were commonly defined as multifocal-multicentric cancers (MFMCC)
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