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Bellini C, Susini T, Toncelli K, Pandolfi M, Migliaro G, Pugliese F, Vanzi B, Incardona L, Bicchierai G, di Naro F, de Benedetto D, Vidali S, Pancani S, Miele V, Nori Cucchiari J. Lesion Conspicuity in Contrast-Enhanced Mammography: A Retrospective Analysis of Tumor Characteristics. Cancers (Basel) 2025; 17:501. [PMID: 39941868 PMCID: PMC11815910 DOI: 10.3390/cancers17030501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/27/2025] [Accepted: 01/29/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND/OBJECTIVES The aim of this study is to evaluate the impact of tumor characteristics on lesion conspicuity in contrast-enhanced mammography (CEM) and identify factors associated with different levels of conspicuity. METHODS In this retrospective study, we analyzed 552 patients with breast cancer who underwent CEM. Lesion conspicuity was categorized into three levels: 1 (low), 2 (moderate), and 3 (high). Tumor characteristics included age, histological subtype, hormone receptor status, HER2 status, Ki67 index, tumor grade, and molecular subtype. Univariate and multivariate analyses were conducted to assess associations between lesion conspicuity and these factors. RESULTS Of the 552 cases, the majority showed mass enhancement (78.1%), followed by non-mass enhancement (NME) (16.8%), and a combination of mass and NME (4.0%). Lesion conspicuity was significantly associated with enhancement type on CEM (p < 0.001). High conspicuity (score 3) was predominantly observed in masses (84.8%) compared to NME (7.6%). Larger tumor dimensions (median 20 mm) were also associated with higher conspicuity (p < 0.001). Molecular subtypes differed significantly in conspicuity, with Luminal A tumors showing lower conspicuity compared to HER2-positive and triple-negative breast cancers (p = 0.025). In multivariate analysis, lesion conspicuity was strongly associated with enhancement type (p < 0.001) and tumor dimensions (p < 0.001), while histological subtype and molecular characteristics had no significant independent impact. CONCLUSIONS Lesion conspicuity in CEM is primarily influenced by the type of enhancement and tumor size. Mass-forming lesions, particularly larger ones, are more conspicuous, while NME tends to result in lower conspicuity. These findings suggest that enhancement patterns and tumor dimensions are key factors to consider when interpreting CEM in breast cancer diagnosis.
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Affiliation(s)
- Chiara Bellini
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Tommaso Susini
- Breast Unit, Gynaecology Section, Department of Health Sciences, University of Florence, 50121 Firenze, Italy;
| | - Kassandra Toncelli
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Martina Pandolfi
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Giuliano Migliaro
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Francesca Pugliese
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Bianca Vanzi
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Ludovica Incardona
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Giulia Bicchierai
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Federica di Naro
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Diego de Benedetto
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Sofia Vidali
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 50143 Firenze, Italy;
| | - Vittorio Miele
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Firenze, Italy;
- Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy
| | - Jacopo Nori Cucchiari
- Breast Imaging Unit, Department of Radiology, Azienda Ospedaliero, Universitaria Careggi, 50134 Firenze, Italy; (K.T.); (M.P.); (G.M.); (F.P.); (B.V.); (L.I.); (G.B.); (F.d.N.); (D.d.B.); (S.V.); (J.N.C.)
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Chung WS, Tang YC, Cheung YC. Contrast-Enhanced Mammography: A Literature Review of Clinical Uses for Cancer Diagnosis and Surgical Oncology. Cancers (Basel) 2024; 16:4143. [PMID: 39766044 PMCID: PMC11674923 DOI: 10.3390/cancers16244143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/08/2024] [Accepted: 12/10/2024] [Indexed: 01/11/2025] Open
Abstract
Contrast-enhanced mammography (CEM) uses intermittent dual-energy (low- and high-energy) exposures to produce low-energy mammograms and recombine enhanced images after the administration of iodized contrast medium, which provides more detailed information to detect breast cancers by using the features of morphology and abnormal uptake. In this article, we reviewed the literature to clarify the clinical applications of CEM, including (1) the fundamentals of CEM: the technique, radiation exposure, and image interpretation; (2) its clinical uses for cancer diagnosis, including problem-solving, palpable mass, suspicious microcalcification, architecture distortion, screening, and CEM-guided biopsy; and (3) the concerns of surgical oncology in pre-operative and neoadjuvant chemotherapy assessments. CEM undoubtedly plays an important role in clinical practice.
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Affiliation(s)
- Wai-Shan Chung
- Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Ya-Chun Tang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 33382, Taiwan;
| | - Yun-Chung Cheung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 33382, Taiwan;
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Upadhyay N, Wolska J. Imaging the dense breast. J Surg Oncol 2024; 130:29-35. [PMID: 38685673 DOI: 10.1002/jso.27661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
The sensitivity of mammography reduces as breast density increases, which impacts breast screening and locoregional staging in breast cancer. Supplementary imaging with other modalities can offer improved cancer detection, but this often comes at the cost of more false positives. Magnetic resonance imaging and contrast-enhanced mammography, which assess tumour enhancement following contrast administration, are more sensitive than digital breast tomosynthesis and ultrasound, which predominantly rely on the assessment of tumour morphology.
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Affiliation(s)
- Neil Upadhyay
- Faculty of Medicine, Imperial College London, London, UK
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Joanna Wolska
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
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Grażyńska A, Niewiadomska A, Owczarek AJ, Winder M, Hołda J, Zwolińska O, Barczyk-Gutkowska A, Modlińska S, Lorek A, Kuźbińska A, Steinhof-Radwańska K. Comparison of the effectiveness of contrast-enhanced mammography in detecting malignant lesions in patients with extremely dense breasts compared to the all-densities population. Pol J Radiol 2024; 89:e240-e248. [PMID: 38938658 PMCID: PMC11210381 DOI: 10.5114/pjr/186180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/17/2024] [Indexed: 06/29/2024] Open
Abstract
Purpose To assess the effectiveness of contrast-enhanced mammography (CEM) recombinant images in detecting malignant lesions in patients with extremely dense breasts compared to the all-densities population. Material and methods 792 patients with 808 breast lesions, in whom the final decision on core-needle biopsy was made based on CEM, and who received the result of histopathological examination, were qualified for a single-centre, retrospective study. Patient electronic records and imaging examinations were reviewed to establish demographics, clinical and imaging findings, and histopathology results. The CEM images were reassessed and assigned to the appropriate American College of Radiology (ACR) density categories. Results Extremely dense breasts were present in 86 (10.9%) patients. Histopathological examination confirmed the presence of malignant lesions in 52.6% of cases in the entire group of patients and 43% in the group of extremely dense breasts. CEM incorrectly classified the lesion as false negative in 16/425 (3.8%) cases for the whole group, and in 1/37 (2.7%) cases for extremely dense breasts. The sensitivity of CEM for the group of all patients was 96.2%, specificity - 60%, positive predictive values (PPV) - 72.8%, and negative predictive values (NPV) - 93.5%. In the group of patients with extremely dense breasts, the sensitivity of the method was 97.3%, specificity - 59.2%, PPV - 64.3%, and NPV - 96.7%. Conclusions CEM is characterised by high sensitivity and NPV in detecting malignant lesions regardless of the type of breast density. In patients with extremely dense breasts, CEM could serve as a complementary or additional examination in the absence or low availability of MRI.
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Affiliation(s)
- Anna Grażyńska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Niewiadomska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Aleksander J. Owczarek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Mateusz Winder
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Jakub Hołda
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Olga Zwolińska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Anna Barczyk-Gutkowska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Sandra Modlińska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Katowice, Poland
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Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97:695-704. [PMID: 38374651 PMCID: PMC11027262 DOI: 10.1093/bjr/tqae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, 84112, United States
| | - Samantha Salmon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
| | - Bradley D Weaver
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, 84112, United States
| | - Laurie L Fajardo
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
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Goh Y, Quek ST, Pillay P, Chou CP. Evaluation of architectural distortion with contrast-enhanced mammography. Clin Radiol 2024; 79:163-169. [PMID: 38114374 DOI: 10.1016/j.crad.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
Architectural distortion (AD) is the third most common abnormality detected on mammograms. In the absence of an accurate non-invasive tool to evaluate ADs, clinical management often requires surgical excision for histological diagnosis. This problem is expected to worsen with the growing use of digital breast tomosynthesis (DBT) and the resultant increasing detection of ADs. There is therefore a great clinical need for a diagnostic imaging tool to complement non-enhanced mammography for the evaluation of AD. Contrast-enhanced mammography (CEM) is an emerging breast imaging method that uses contrast media and the principle of dual-energy subtraction to evaluate vascularity of suspicious breast lesions. CEM, a cost-effective alternative to breast magnetic resonance imaging (MRI), can be used to evaluate AD by juxtaposing CEM images with non-enhanced mammograms for comparison. In this review, the authors aim to provide readers with an overview of the interpretation of AD on CEM using imaging examples. Relevant imaging features of CEM and their respective significance will be matched with information from a literature review. Finally, the authors would like to highlight the added value of CEM in relevant clinical applications in the assessment of AD.
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Affiliation(s)
- Y Goh
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - S T Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - P Pillay
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - C-P Chou
- Kaohsiung Veterans General Hospital, Radiology Department, No. 386, Dazhong 1st Rd, Zuoying Dist., Kaohsiung City 81362, Taiwan, ROC.
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