Comparison of Contrast-Enhanced Spectral Mammography and Contrast-Enhanced MRI in Screening Multifocal and Multicentric Lesions in Breast Cancer Patients

Abstract

Objectives: We aimed to determine the difference between contrast-enhanced spectral mammography (CESM) and contrast-enhanced magnetic resonance imaging (CE-MRI) in detecting multifocal and multicentric breast cancer (MMBC).

Methods: : This study was conducted among breast cancer patients between July 1, 2017, and May 30, 2021. The sensitivity, specificity, and accuracy of CESM and CE-MRI in the diagnosis of MMBC were evaluated with pathological results as the gold standard.

Results: A total of 188 lesions were detected in 54 patients with MMBC, including 177 breast cancer and 11 benign lesions. Based on CESM and CE-MRI, 4 false-positive cases and 3 false-negative cases and 7 false-positive cases and 1 false-negative case, respectively, were found. The accuracy of CESM was higher than that of MRI (96.3% vs 95.7%), and the specificity was higher than that of MRI (63.6% vs 36.4%). There were no significant differences in the sensitivity, specificity, and accuracy for the detection of MMBC between CESM and CE-MRI (p = 0.500; p = 0.250; p = 0.792).

Conclusion: CESM is an effective method for the detection of MMBC, which is consistent with the sensitivity and accuracy of CE-MRI.

Figure 1

Imaging features of a 54-year-old female with left-sided MMBC. (a) Breast US indicated only an irregular solid hypoechoic mass in the left breast (triangle), which was diagnosed as BI-RADS 4C. (b) MLO position in left breast. In CESM, the LE-MG imaging indicated two masses with unclear and irregular edges in the outer upper quadrant of the breast (arrow). (c) In CESM, the RSM imaging indicated the weak and significantly heterogeneous enhancement of masses. Two masses were diagnosed as BI-RADS 4C. (d, e) The patient received CE-MRI again due to disputes in the results of the US and CESM. The MIP imaging obtained after CE-MRI at transverse and coronal views. They indicated two significantly heterogeneous enhancements of masses with spiculated edges (arrows), which were diagnosed as BI-RADS 4C. (f) The posterior mass was confirmed to be invasive lobular carcinoma after surgery. The HE staining results were observed under a magnification of 10×. (g) The anterior mass was invasive lobular carcinoma and DCIS. HE staining results were observed under a magnification of 20×.

Figure 2

Imaging features of a 39-year-old woman with MMBC in the right breast. (a) CC position in the right breast. In CESM, the LE-MG imaging indicated a star-shaped mass in the outer quadrant of the right breast (arrow). (b) In CESM, the RSM imaging indicated six slightly enhanced masses with irregular edges and not circumscribed margin (arrows). (c) Enlarged LE-MG imaging: there were clusters of fine linear branching calcifications. Combined with the RSM imaging, the six small masses were diagnosed as BI-RADS 5. (d) US indicated only two hypoechoic masses with irregular edges (crosses), which was classified as BI-RADS 4A. Six masses were confirmed as IDC after surgery. (e) The pathology features of HE under a magnification of 20×. (f) The smallest mass was DCIS with a diameter of 3 mm. The HE staining results were observed under a magnification of 10×.

Figure 3

Imaging features of a 45-year-old woman with MMBC in the left breast. (a) CC position in the left breast. In CESM, the LE-MG imaging indicated dense breast parenchyma with no suspicious findings. (b) In CESM, the RSM imaging indicated the first mass with irregular edge and significantly heterogeneous enhancement in the outer quadrant (arrow), which was diagnosed as BI-RADS 4C. The second and third irregular masses along the duct were seen in the inner quadrant, with mild enhancement (triangles). They were diagnosed as BI-RADS 4B. (c) US indicated a hypoechoic nodule with irregular edge (triangles), which was diagnosed as BI-RADS 4C. (d–f) T1WI image of CE-MRI fat compression in axial position showed three nodules in the left breast. The morphology and location were consistent both on CESM and CE-MRI. They were also diagnosed as BI-RADS 4C and 4B, respectively (arrows). (g) The first mass was confirmed to be IDC after surgery by HE staining under a magnification of 20×. (h) The second and third masses were DCIS, by HE staining under a magnification of 10×.

Figure 4

Imaging features of a 45-year-old woman with breast cancer in the right breast. (a) MLO position in the right breast. In CESM, the LE-MG imaging indicated dense breast parenchyma with no suspicious findings. (b) In CESM, the RSM imaging indicated the first mass with long spiculated edge, with significantly heterogeneous enhancement (wide arrow), which was diagnosed as BI-RADS 5. Under the right papilla, there was another small mass with significant enhancement and round margin (narrow arrow), which was diagnosed as BI-RADS 3. (c, d) T1WI image of CE-MRI fat compression in axial position: the morphology and location of the two lesions were consistent on both CESM and CE-MRI, which were diagnosed as BI-RADS 5 and 3, respectively. (e) US indicated only a hypoechoic mass with irregular edge (crosses), which was diagnosed as BI-RADS 4C. (f) It was confirmed that the first mass was an IDC, as revealed by HE staining under a magnification of 20×. The second mass was a small subcutaneous hemangioma.

Figure 5

Imaging features of a 50-year-old woman with MMBC in the right breast. (a, b) CC position in the right breast. In CESM, the LE-MG and RSM imaging indicated asymmetric density shadow in the inner quadrant, with mild ductal enhancement (wide arrow). (c, d) MLO position in the right breast. In CESM, the LE-MG and RSM imaging indicated asymmetric density shadow in the lower quadrant, with mild ductal enhancement (wide arrow). The diagnosis was BI-RADS 4A. The pectoralis major muscle was not well displayed, which may not be diagnosed. (e) US indicated a hypoechoic mass with irregular edge (crosses), which was diagnosed as BI-RADS 4C. (f, g) T1WI image of CE-MRI fat compression in axial position showed the first mass with irregular and heterogeneous enhancement, which could be seen in the lower inner quadrant of the right breast (wide arrow). The second lesion showed non-mass and ductal enhancement around the mass (wide arrow). (h) The first mass was confirmed to be IDC after surgery, as shown in HE staining under a magnification of 20×. (i) The non-mass lesion was DCIS, as shown in HE staining under a magnification of 10×.