Diagnostic Performance Of Contrast-Enhanced Spectral Mammography In Breast Lesions With Suspicious Calcification And Its Effect On Surgical Decision Making

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Diagnostic value of contrast-enhanced spectral mammography of breast lesions with suspicious calcificationObjective: To evaluate the diagnostic value of contrast-enhanced spectral mammography(CESM)in differentiating malignant from benign breast lesions with suspicious calcification.Methods: A retrospective review was performed on 103 patients with breast lesions with suspicious calcification(103 total lesions,including 49 benign lesions and 54 malignant lesions)confirmed on the low energy(LE)images by CESM examination between April 2017 to April 2019 in the Third Affiliated Hospital of Soochow University.All the pathological results were obtained after biopsy or surgery.Image analysis was performed by two experienced breast radiologists.The BI-RADS score was calculated on the LE images,and the degree of lesion enhancement was assessed on the subtraction images.The CESM score was calculated according to the BI-RADS score and the degree of lesion enhancement.Using the pathological results as the golden standard,the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of LE,subtraction images,and CESM in differentiating malignant from benign breast lesions with suspicious calcification,and the diagnostic sensitivity and specificity were calculated.Z test was assessed to compare the area under the ROC curve(AUC).P < 0.05 was considered to indicate a significant difference in all statistical tests.Results: The AUCs of the BI-RADS score,the degree of lesion enhancement,and the CESM score in differentiating malignant from benign breast lesions with suspicious calcification were 0.82,0.91,and 0.97,respectively.The AUC of the CESM score was significantly higher than those of the BI-RADS score and the degree of lesion enhancement(Z = 4.45,P < 0.001;Z = 2.54,P = 0.011).There was no statistical difference in the AUC between the BI-RADS score and the degree of lesion enhancement(Z = 1.68,P = 0.093).The diagnostic sensitivity of the BI-RADS score,the degree of lesion enhancement,and the CESM score in differentiating malignant from benign breast lesions with suspicious calcification were 75.93%,94.44%,and 90.74%,respectively.The diagnostic specificity of the BI-RADS score,the degree of lesion enhancement,and the CESM score in differentiating malignant from benign breast lesions with suspicious calcification were 73.47%,71.43% and 95.92%,respectively.Conclusion: CESM with the advantages of both LE and subtraction images improves the diagnostic efficiency in differentiating malignant from benign breast lesions with suspicious calcification.Part ? Effect of contrast-enhanced spectral mammography on surgical decision making for malignant breast lesions with calcificationObjective: To evaluate the diagnostic accuracy of contrast-enhanced spectral mammography(CESM)in assessing the size of malignant breast calcification lesions and the influence in surgical decision making.Methods: A retrospective review was performed on 54 patients with 54 malignant breast calcification lesions which were confirmed by pathology between April 2017 to April 2019 in Third Affiliated Hospital of Soochow University.All patients underwent CESM examination before the surgery and suspicious calcification was detected on the low energy(LE)images.Image analysis was performed by two experienced breast radiologists.The extent(maximum diameter)of breast lesion was assessed on LE images and CESM.The preferred surgical decision(breast conserving surgery or mastectomy)was determined based on the imaging performance.The intraclass correlation coefficient(ICC)and Bland-Altman method were used to evaluate the consistency between the imaging maximum diameter and the histopathological maximum diameter of the breast lesions.The Mc Nemars test was used to compare the differences between the surgical decision determined based on the imaging performance and the final surgical procedure.P < 0.05 was considered to indicate a significant difference in all statistical tests.Results: The maximum diameter of breast lesion on the LE images was 2.89 ± 1.86 cm,and the maximum diameter of breast lesion on the CESM was 3.25 ± 2.02 cm.The ICC for the maximum diameter on the LE images and the histopathological maximum diameter was 0.86,and the ICC for the maximum diameter of breast lesion on the CESM and the histopathological maximum diameter was 0.96.The mean differences in the maximum diameter between LE images and histopathology and between the CESM and histopathology were ?0.21 cm(95% CI: ?2.12 cm,1.69 cm)and 0.15 cm(95% CI: ?0.82 cm,1.12 cm).Based on LE images,breast conserving surgery was recommended for 44.44% of patients,and mastectomy was recommended for 55.56% of patients.There was a significant difference between the surgical decision determined based on LE images and the final surgical procedure(P = 0.008).Based on CESM,breast conserving surgery was recommended for 25.93% of patients,and mastectomy was recommended for 74.07% of patients.There was no significant difference between the surgical decision determined based on CESM and the final surgical procedure(P = 0.125).Conclusion: CESM combined LE with subtraction images has a high diagnostic accuracy in assessing the extent of malignant breast lesions with calcification,and can also provide a basis for preoperative surgical decision making.