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. 2020 Dec;184(3):723-731.
doi: 10.1007/s10549-020-05881-2. Epub 2020 Aug 28.

Clinical performance of contrast-enhanced spectral mammography in pre-surgical evaluation of breast malignant lesions in dense breasts: a single center study

Anna Bozzini  1 , Luca Nicosia  1 , Giancarlo Pruneri  2   3 , Patrick Maisonneuve  4 , Lorenza Meneghetti  1 , Giuseppe Renne  5 , Andrea Vingiani  2   3 , Enrico Cassano  1 , Mauro Giuseppe Mastropasqua  6   7
Affiliations

Clinical performance of contrast-enhanced spectral mammography in pre-surgical evaluation of breast malignant lesions in dense breasts: a single center study

Anna Bozzini et al. Breast Cancer Res Treat. 2020 Dec.

Abstract

Purpose: To 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.

Methods: This 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.

Results: Overall, 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).

Conclusions: Our 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.

Keywords: Breast malignant lesions; Contrast-enhanced spectral mammography; Full field digital mammography; Magnetic resonance; Ultrasound.

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Conflict of interest statement

We have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
a CC FFDM projection showing a dense breast. b CC projection of the same breast on the CESM iodine content image revealing multiple neoplastic nodules
Fig. 2
Fig. 2
a MLO FFDM projection showing a dense breast. b MLO projection of the same breast on CESM, iodine content image revealing breast cancer
Fig. 3
Fig. 3
a MLO CESM iodine content image projection showing a principal centimeter diameter breast cancer within the inner quadrant, and a sub-centimetric satellite lesion. b The breast cancer and satellite nodule are seen in the contrast-enhanced MR image
Fig. 4
Fig. 4
a CC FFDM projection showing a dense breast. b CC projection on CESM iodine content image showing diffuse breast cancer
See this image and copyright information in PMC

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