Research Presentation Session: Breast

RPS 802 - Applications of contrast-enhanced mammography (CEM)

February 29, 09:30 - 11:00 CET

7 min
A large-scale single-centre evaluation of enhanced mammography (CEM) in the pre-operative staging of breast cancer
Francesca Pugliese, Florence / Italy
Author Block: F. Pugliese, G. Migliaro, G. Bicchierai, C. Bellini, D. De Benedetto, F. Di Naro, L. A. Incardona, V. Miele, J. Nori; Florence/IT
Purpose: The purpose of this study was to evaluate the role and efficacy of contrast enhanced mammography in the pre-operative management of patients with biopsy-proven breast cancer.
Methods or Background: We selected 524 patients with breast cancer who underwent CEM as preoperative staging and had breast cancer-related surgery at our institution, between 2017 and 2020. We analysed those cases in which CEM led to additional imaging or biopsy and those in which it changed the type of surgery. CEM sensitivity in identifying the index lesion and sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy in the correct preoperative staging of breast cancer of the whole population and in various subgroups were calculated.
Results or Findings: CEM changed the surgical plan in 22.48% of cases (118/525 patients) when the extension of the index lesion was different from what was previously detected by conventional imaging or when an additional lesion was detected. The sensitivity, specificity, PPV and NPV, and accuracy of CEM were 94.74%, 95.86%, 86.40%, 98.5%, diagnostic accuracy was 95.62% and AUC of ROC curve was 0.953. Conclusively, after using a chi-square test, the statistical analysis showed a higher diagnostic performance in patients with palpable lesions vs patients with non-palpable ones (p=0.0022).
Conclusion: CEM changed the surgical plan in 22.48% of our series, proving to be an accurate exam in the presurgical staging of breast cancer. CEM diagnostic performances support its reliability in the presurgical staging setting, for a lesion-tailored management, leading to the best surgical plan, avoiding over- or undertreatment.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: This study is retrospective.
7 min
Outcomes of surveillance using contrast-enhanced mammography in women with a personal history of breast cancer
Bruce Mann, Parkville / Australia
Author Block: J. Matheson1, A. Rose1, C. Nickson2, K. Elder1, B. Mann1; 1Parkville, VIC/AU, 2Sydney, NSW/AU
Purpose: Annual mammography with selective ultrasound is standard for women with Personal History of Breast Cancer (PHBC). Rates of interval cancers of 3.6 per 1000 screens have been reported. Earlier diagnosis of recurrences and new cancers may allow more effective treatment. This study aimed to clarify the utility of contrast-enhanced mammography (CEM), a more sensitive scan than conventional mammography and comparable to MRI, for surveillance.
Methods or Background: This was a retrospective study of 1,190 women with PHBC undergoing CEM surveillance between June 2016 and December 2022. Outcomes of initial CEM and subsequent imaging were collected, including incident surveillance-detected and interval cancers, recalls for assessment, and pathology and treatment details. Descriptive statistics and hazards modelling was used.
Results or Findings: There were 3,784 surveillance episodes: 1,190 first CEMs and 2,594 subsequent surveillance episodes. 79% of women had at least three annual rounds of surveillance. 186/3784 surveillance episodes were recalled for assessment (recall rate 4.9%). 72 (39%) recalled cases were true positive- 50 invasive and 22 DCIS. The cancer detection rate was 19/1000. 51% of recalls were due to contrast and 35% of these were true positive. Invasive cancers were predominantly stage 1 (64%) or stage 2 (32%) and most were grade 2 (44%) or grade 3 (47%). The median invasive cancer size was 16mm (IQR 9-25mm). The rate of symptomatic interval cancers was 0.8 per 1000 screens (program sensitivity 96.0%). Surveillance-detected cancer rates differed significantly by index cancer subtype (χ2=11.9, p=0.0026), with the highest rates for women with TNBC.
Conclusion: Routine CEM in surveillance of women with PHBC led to higher cancer detection and lower interval cancer rates than published series. CEM appears to increase the sensitivity of surveillance programs for women with PHBC. This may allow more effective treatment.
Limitations: This was a single institution study.
Funding for this study: Funding was received by an unrestricted grant from Hologic.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Melbourne Health Research and Ethics Committee, QA2019129.
7 min
Contrast-enhanced mammography in local staging of screen-detected breast cancer
Allison Rose, Fitzroy / Australia
Author Block: C. MacCallum1, B. Mann1, C. Nickson2, A. Rose1; 1Parkville, VIC/AU, 2Carlton, VIC/AU
Purpose: BreastScreen Australia provides assessment of suspected breast cancer to the point of diagnosis using conventional imaging and percutaneous biopsy. Comprehensive local staging is not performed. The purpose of this study was to introduce contrast-enhanced mammography (CEM) for local staging of screen-detected cancer at our academic hospital. We report findings for otherwise occult disease and impact on treatment.
Methods or Background: Women with screen-detected cancer undergoing staging CEM between November 2018 and April 2022 were identified retrospectively. Additional contrast-detected abnormalities were investigated with preoperative percutaneous biopsy, surgical biopsy, or problem-solving MRI. Findings were recorded. Invasive cancer or DCIS were considered as true positives (TP) and other findings as false positives (FP). Impact on surgical decisions was assessed.
Results or Findings: 204 patients underwent CEM, of whom 62/204 (30%) had 76 additional abnormalities. 36/76 (47%) were TP and 40/76 (53%) FP. CEM identified malignant occult lesions (mOLs) in 30/204 patients (15%). 75% moLs were invasive and 25% DCIS. 83% (30/36) of mOLs were ipsilateral. Most invasive mOLs were Grade 2 (20/27, 74.1%). Patients with higher background parenchymal enhancement (BPE) had a higher rate of mOLs (20% for moderate/marked vs 4% for minimal/mild, p=0.0023). No statistically significant differences were found by mammographic density or age. Surgical management was changed in 45/204 (22%) patients, 30 with mOLs and 15 with benign and atypical proliferative lesions. Altered surgery included wider resection (24/45), conversion to mastectomy (8/45), contralateral breast surgery (6/45), additional ipsilateral excision (5/45), and bracketing (2/45).
Conclusion: CEM for local staging of screen-detected cancers identified additional malignant lesions in 15% of patients (particularly those with higher BPE), with many clinically significant lesions. Findings led to surgical management change in 22% of patients. Larger studies with oncological outcomes are needed.
Limitations: This was a single arm study. Larger numbers and oncological outcomes are needed to overcome the limitations of this study.
Funding for this study: Funding was received by a research grant supported by Hologic.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by a Quality Assurance project by the Melbourne Health Research and Ethics Committee.
7 min
Comparison of the diagnostic accuracy of contrast-enhanced spectral mammography with delayed image and digital mammography in the diagnosis of breast cancer in BI-RADS 4 mammographic findings
Akmaral Ainakulova, Almaty / Kazakhstan
Author Block: A. Ainakulova, Z. J. Zholdybay, D. Kaidarova, Z. M. Amankulov, M. Gabdulina; Almaty/KZ
Purpose: The purpose of this study is to compare the diagnostic accuracy of contrast-enhanced spectral mammography (CESM) with delayed image and digital mammography (DM) in breast cancer detection in BI-RADS 4 mammographic findings among mass lesions, suspicious microcalcifications, asymmetries, and architectural distortions.
Methods or Background: Between September 2018 and May 2021, mammographic examinations of 1968 women were carried out according to clinical indicators. According to the results of mammographic examination, BI-RADS 4 mammographic findings were revealed in 374 (19%) patients, requiring differential and clarifying diagnostics. All 374 patients underwent CESM with delayed image. All lesions were histologically verified. Lesions were categorised based on ACR BI-RADS Fifth Edition. On CESM with delayed image, lesions were categorised by dynamic patterns of contrast enhancement.
Results or Findings: Of the 398 lesions identified, 208 (52.26%) were malignant and 190 (47.73%) were benign. Mass lesions were detected in 240 (64.2%) women, suspicious microcalcifications in 60 (16%) women, architectural distortions in 31 (8.3%) women, and asymmetry in 43 (11.5%) women. For DM and CESM with delayed image among mass lesions sensitivity was 82.1% and 95.5%; specificity was 51.4% and 89.2% respectively. For DM and CESM with delayed image among suspicious microcalcifications, asymmetries, and architectural distortions, sensitivity was 100%, whereas specificity was 82% and 97.4%; 65% and 96.3%; 57.1% and 94.1% respectively. The ROC curve of all BI-RADS 4 mammographic findings had an area under the curve of 0.965 for CESM with delayed image, and of 0.749 for DM (p=0.000).
Conclusion: CESM with delayed image showed high sensitivity and specificity in the diagnosis of breast cancer among mass lesions. CESM with delayed image significantly increased specificity in the diagnosis of breast cancer among microcalcifications, asymmetries, and architectural distortions, and may be helpful to avoid unnecessary biopsies in BI-RADS 4 mammographic findings.
Limitations: The study used a small number of patients with suspicious microcalcifications, asymmetries, and architectural distortions.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: No information provided by the submitter.
7 min
Diagnostic performance of lesion conspicuity and contrast-to-noise ratio (CNR) values on contrast-enhanced-mammogram (CEM) recombined images in predicting malignancy
Iris Allajbeu, Cambridge / United Kingdom
Author Block: I. Allajbeu, R. Manavaki, M. Nanaa, N. Healy, V. Papalouka, N. Payne, F. Gilbert; Cambridge/UK
Purpose: The purpose of this study was to compare the diagnostic performance of lesion conspicuity and contrast-to-noise ratio (CNR) on CEM recombined images in differentiating benign and malignant lesions.
Methods or Background: CEM examinations with BI-RADS scores of 3-5 and histopathologically confirmed findings were eligible for inclusion. Two breast radiologists assessed lesion conspicuity as low, moderate, or high, based on the BIRADS CEM lexicon. Two regions-of-interest (ROI) representing lesion and background, respectively, were delineated on the early (CC) and late (MLO) views to calculate CNR1 and CNR2, respectively, using CNR=(Sa-Sb)/Sb (Sa: maximum value in the lesion ROI, Sb: mean value in the background ROI). Associations between nominal, or continuous and nominal variables were assessed using chi-squared test or rank-biserial correlation coefficient (rrb) respectively. Receiver operating characteristic (ROC) curves and area-under-the curve (AUC) were used to assess diagnostic performance. p values < 0.05 were deemed statistically significant.
Results or Findings: Of 143 lesions, 85 were normal/ benign and 58 malignant confirmed by histopathology. All high conspicuity lesions were invasive cancers (9/9, 100%) with 82% (49/60) low conspicuity lesions being normal/ benign, and 78% (45/58) malignant lesions showing either moderate or high conspicuity (χ2=60.1, p<.001). Malignancy was associated with increased CNR1 (rrb=0.65, p<.001) and CNR2 (rrb=0.41, p<.001) values. CNR1 performed better in differentiating benign from malignant lesions (AUC 0.75, accuracy: 71%, sensitivity: 80%, specificity 63%) than CNR2 (AUC 0.71, accuracy: 68%, sensitivity: 71%, specificity 65%) or lesion conspicuity (AUC: 0.75%, accuracy: 71%, sensitivity: 80%, specificity: 64%).
Conclusion: Both conspicuity and CNR quantitative assessment of enhancing lesions on CEM can improve specificity in differentiating benign from malignant breast disease. Quantitative measurement of lesion enhancement performs better than conspicuity in predicting malignancy, with CNR calculated on the early view offering the best diagnostic performance.
Limitations: This was a single centre retrospective study with a limited dataset.
Funding for this study: Funding was received as part of the BRAID trial.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the BRAID trial (IRAS project ID: 25137).
7 min
Feasibility and performance of contrast-enhanced tomosynthesis compared to contrast-enhanced MRI
Paola Clauser, Vienna / Austria
Author Block: P. Clauser1, N. Pötsch1, P. Kapetas1, M. Hörnig2, M. Weber1, R-I. Milos1, P. A. Baltzer1, T. H. Helbich1; 1Vienna/AT, 2Forchheim/DE
Purpose: The performance of contrast-enhanced mammography (CEM) is limited by the 2D image acquisition. We hypothesise that contrast-enhanced tomosynthesis (CE-DBT) could allow for improved lesion characterisation, truly comparable to contrast-enhanced magnetic resonance imaging (CE-MRI). The aim of our analysis was to compare the diagnostic performance of a CE-DBT prototype with CE-MRI.
Methods or Background: Women presenting with suspicious findings on mammography, DBT, or ultrasound were invited to participate in the study. Participants underwent CE-DBT of the breast with suspicious findings using a dedicated prototype. The suspicious findings were biopsied and only histologically verified lesions were included in the analysis. Four readers (R1 and R2 non-experienced; R3 and R4 experienced) evaluated the images, blinded to patients’ history, previous imaging, and histology. The readers evaluated CE-MRI and CE-DBT (including DBT and synthetic mammography) in separate sessions and gave a BI-RADS score for each finding. Sensitivity and specificity were calculated and compared.
Results or Findings: We included 84 patients (mean age 56 years, range 39-70) with 91 histologically verified breast lesions (27 benign, 64 malignant). Sensitivity was comparable between CE-DBT and CE-MRI for R3 (both 100%), while sensitivity was higher with CE-MRI than with CE-DBT for the other readers (CE-DBT raging from 89 to 94%, CE-MRI from 97 to 100%). Specificity was overall higher for experienced than for non-experienced readers. Specificity improved with CE-MRI for non-experienced readers, while no significant difference was detected between CE-DBT and CE-MRI for experienced readers.
Conclusion: Our study showed that CE-DBT has a good diagnostic performance for the characterisation of breast lesions, almost comparable to that of CE-MRI of the breast.
Limitations: This was a single centre, cancer enriched dataset.
Funding for this study: Funding for this study was received from Siemens Healthcare GmBH.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Ethics Committee and patients gave written informed consent.
7 min
Preoperative contrast mammography vs MRI: which one is better?
Carmen Mbongo, Pamplona / Spain
Author Block: C. Mbongo, M. B. Barrio Piqueras, P. Malmierca Ordoqui, M. Jiménez Vázquez, A. Elizalde, L. J. Pina Insausti; Pamplona/ES
Purpose: The aim of this study was to compare the sensitivity and accuracy of Contrast Mammography (CEDEM) vs MRI as preoperative imaging techniques.
Methods or Background: This is a retrospective lesion-based study. From January 2018 to December 2019, 77 patients underwent CEDEM, MRI and percutaneous biopsy at our centre as a part of the breast lesion preoperative protocol. CEDEM and MRI images were then reviewed, and BI-RADS categorisation for each lesion was subsequently collected. The final histopathologic report was also assessed and considered the gold standard. BI-RADS categories 1 to 3 were considered negative, while 4 and 5 were classified as positive. A McNemar test was used to compare the sensitivity of both imaging techniques, and ROC curves were performed to assess the areas under the curve, both using SPSS statistical software.
Results or Findings: The 77 female patients (37-84, mean 55.5 y/o) showed 98 lesions with pathologic correlation (16 benign; 82 malignant: 77 invasive ca, of which 43 were LumA, 22 LumB, 6 pure Her2, 6 Triple negative, and finally 5 DCIS). The sensitivity of CEDEM vs MRI was 83.3% vs 97.6% (p=0.002). The areas under the curve were 0.87 vs 0.86 (p=0.9), respectively.
Conclusion: Although MRI is significantly more sensitive than CEDEM, the accuracy was similar for both modalities.
Limitations: We had a low number of cases; it was a monocentric study, and no intra/interobserver variability was studied.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: No information provided by the submitter.
7 min
Tumour involvement of the nipple at preoperative contrast-enhanced mammography (CEM): preliminary results of a multicentre diagnostic accuracy study
Thiemo van Nijnatten, Maastricht / Netherlands
Author Block: T. van Nijnatten1, A. Cozzi2, R. Alcantara3, G. Della Pepa4, J. James5, C. Depretto4, G. P. Scaperrotta4, S. Schiaffino2; 1Maastricht/NL, 2Lugano/CH, 3Barcelona/ES, 4Milan/IT, 5Nottingham/UK
Purpose: The aim of this study was to assess the diagnostic accuracy of contrast-enhanced mammography (CEM) in the prediction of pathologic nipple involvement, CEM diagnostic accuracy was also compared with contrast-enhanced breast MRI scans.
Methods or Background: This retrospective multicentre study included patients with biopsy-proven breast cancer who underwent preoperative CEM in three referral centres (Italy, Spain, the Netherlands), between April 2013 and June 2023. Patients were included if they did not undergo neoadjuvant therapy and if they underwent either mastectomy or central lumpectomy. After local image review by board-certified breast radiologists (5-to-10 years of experience), the diagnostic performance of CEM in predicting nipple involvement was calculated, taking surgical pathology as the reference standard and compared with MRI (McNemar’s test) in a subset of patients.
Results or Findings: A total 70 patients (median age 64 years, interquartile range 51–73 years) with breast cancer (50/70 invasive ductal carcinoma, 16/70 invasive lobular carcinoma, 4/70 pure DCIS) were included in the analysis, 59/70 also having undergone MRI. Nipple involvement at surgical pathology was found in 25/70 cases (35.7%). Considering all 70 patients, CEM had a 72.0% sensitivity (95% CI 50.6–87.9%) and an 88.9% specificity (95% CI 76.0–96.3%) for the prediction of pathological nipple involvement. All seven false negative cases presented as non-mass enhancement lesions without peri-areolar skin thickening. Among the 59 patients with both CEM and MRI, CEM had a 65.0% sensitivity (95% CI 44.1–85.9%), significantly lower (p=0.014) than the 95.0% sensitivity of MRI (95% CI 85.4–100%), whereas no significant differences (p=0.179) were found between CEM specificity (97.4%, 95% CI 92.5–100%) and MRI specificity (89.7%, 95% CI 80.2–99.3%).
Conclusion: Preoperative CEM showed moderate sensitivity and high specificity in assessing nipple involvement. Compared to MRI, CEM had significantly lower sensitivity and non-significantly higher specificity.
Limitations: The study is limited by its reliance on preliminary data, as well as the exclusion of NAT patients.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study is a pooled analysis of data from other studies, which received approval from Ethics Committees in three different centres (Maastricht University Medical Centre +, the Netherlands; Hospital Del Mar, Barcelona, Spain; and the Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy).
7 min
Nipple sparing mastectomy: can CEM predict the nipple–areola complex (NAC) involvement?
Giuliano Migliaro, Florence / Italy
Author Block: G. Migliaro, C. Bellini, G. Bicchierai, F. Di Naro, D. De Benedetto, F. Pugliese, L. A. Incardona, V. Miele, J. Nori; Florence/IT
Purpose: The purpose of this study was to assess the role of Contrast-Enhanced Mammography (CEM) as a predictor of invasion of the NAC in patients undergoing nipple-sparing mastectomy (NSM).
Methods or Background: In our retrospective study, three radiologists reviewed 1479 presurgical CEMs of patients who underwent NSM for biopsy proven malignant lesions, conducted at our centre between 2018 and 2019, in consensus. We included 64 CEMs of 64 patients; we evaluated the TND (tumour-nipple distance) dividing patients according to the shortest TND seen either in CC or in MLO. The correct extension of the disease, the enhancement type, and the enhancing conspicuity were described for every lesion. Sensitivity, specificity, negative, and positive predictive values of CEM for nipple invasion (PPV and NPV) were calculated. Our gold standard was the final histology of the surgical specimen.
Results or Findings: The patients were beween 38 and 84 years old (mean age 56.9, median age 52). The shortest TND between the two projections varied from 0mm to 75mm. Among the lesions with TND≤10mm (25/64), 19/25 (76%) resulted as invading the NAC while 6/25 did not; three had a low enhancement conspicuity, and 22 had a moderate or high conspicuity. Amid the lesions with TND>10mm (39/64), only 7/39 (18%) invaded the NAC. Conversely, 32/39 did not; five had a low enhancement conspicuity and 34 had a moderate or high conspicuity. Comparing the two groups of lesions, satisfying NPV (82.1%) and specificity (84.2%) emerged and acceptable VPP and sensitivity (76% and 73%) were reported. No statistical significance emerged.
Conclusion: CEM is a useful tool that can help predict the NAC invasion in pre-surgical assessments, excluding when it is not infiltrated due to the high NPV and specificity of this series.
Limitations: The study is limited by the small number of patients included.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: This is a retrospective study.
7 min
Is late-phase contrast-enhanced mammography after neoadjuvant therapy useful?
Dilşah Oral, Izmir / Turkey
Author Block: D. Oral, Ç. R. Açar, A. B. Kale, O. Acar, I. Ş. S. Örgüç; Manisa/TR
Purpose: This study aims to evaluate the need for late-phase contrast-enhanced mammography (CEM) in assessing post-treatment residual tumor in breast cancer patients undergoing neoadjuvant therapy (NAT).
Methods or Background: In this prospective study, 61 patients were included. CEM examinations, comprising both early and late-phase mediolateral oblique images, were conducted before and after NAT. During the evaluation of CEM images, we separately noted the level of enhancement and the size of index malignant lesions for both phases. Findings were compared with post-surgical pathology reports.
Results or Findings: Residual lesions were detected in 40 (65.57%) patients in pathology. The sensitivity of both early and late-phase images in determining complete response was 90.47%. While the specificity was 55% in the early phase, it increased to 65% in the late phase. Area under curve was 0.727 and 0.777 for early and late-phase images, respectively in ROC analysis. In the correlation analysis for residual lesion size, a significant correlation (p<0.01) was observed between pathological results and both images. Notably, late-phase images exhibited a high degree of correlation, with an R-value of 0.887 compared to 0.867 for the early-phase images. Among 23 patients, when comparing late-phase images to early-phase images, higher contrast enhancement levels were observed in four (17%) lesions, an increase in size in twelve (52%) lesions, and both phenomena in seven (30%) lesions. Among the 19 lesions that exhibited larger residual lesion sizes in late-phase images, 18 of them were more closely aligned with pathological results and one was in complete response in pathological reports.
Conclusion: In our study, late-phase images provided better results in determining the residual tumor compared to the early phase in 29.50% of the patients.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Clinical Research Ethics Committee of Manisa Celal Bayar University (Decision Number : E-85252386-050.04.04-200753).
7 min
Inter-reader agreement between breast imagers using the first version of the BI-RADS CEM lexicon
Calogero Zarcaro, Palermo / Italy
Author Block: C. Zarcaro1, A. Santonocito2, L. Zeitouni3, F. Ferrara4, P. Kapetas5, R-I. Milos5, T. H. Helbich5, P. A. Baltzer5, P. Clauser5; 1Palermo/IT, 2Turin/IT, 3Riyadh/SA, 4Rome/IT, 5Vienna/AT
Purpose: The aim of this study was to evaluate the inter-reader agreement of the Contrast Enhanced Mammography (CEM) lexicon, a new addition to the 5th edition of the BI-RADS Mammography lexicon.
Methods or Background: Three breast imaging fellows reviewed 462 lesions in 421 routine clinical breast CEM in a IRB-approved, single-center, retrospective study using the first version of the CEM BI-RADS lexicon and the fifth edition of the BI-RADS Mammography lexicon. Blinded to patient outcomes, the readers assessed breast and lesion features on low-energy (LE) images (ACR breast density, type of lesion, associated architectural distortion), lesion features in recombined (RC) images (type of enhancement, lesion conspicuity, mass shape, mass margin, mass internal pattern of enhancement, non-mass distribution, non-mass internal pattern of enhancement, enhancing asymmetry), and provided a final BI-RADS assessment. Inter-reader agreement was calculated for each feature using Fleiss’ and Cohen’s kappa coefficient. Sensitivity and specificity were calculated.
Results or Findings: On both LE and RC images, there was moderate to substantial inter-reader agreement for breast density and many lesion features, particularly for type of lesion (k=0.654) and type of enhancement (k=0.664). Agreement was moderate to substantial also on CEM mass enhancement descriptors, while it was fair to moderate for non-mass enhancement and enhancing asymmetry descriptors. Inter-reader agreement for final LE and CEM BI-RADS assessment was moderate (ĸ=0.421) and fair (ĸ=0.364). Sensitivity and specificity were high, although specificity was more variable.
Conclusion: On both LE and RC images, there was moderate to substantial inter-reader agreement for the assessment of breast density and many imaging findings. Agreement was moderate to substantial on CEM mass enhancement, while it was fair to moderate for non-mass enhancement and enhancing asymmetry descriptors.
Limitations: This was a single-centre study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the relevant Institutional Review Board (IRB).
7 min
Preoperative assessment of nipple-areolar complex infiltration: is CEM as reliable as breast MRI?
Silvia Sanità, Udine / Italy
Author Block: S. Sanità, M. Lorenzon, M. Cirillo, L. Cereser, R. Girometti, C. Zuiani; Udine/IT
Purpose: The purpose of this study was to compare sensitivity and specificity of Contrast Enhanced Mammography (CEM) and breast Magnetic Resonance Imaging (MRI) in the assessment of the infiltration of nipple-areolar complex (NAC) in pre-operative assessment.
Methods or Background: We retrospectively included all patients over the age of 18 with newly diagnosed, biopsy-proven breast cancer, who underwent either CEM or 1.5T MRI between January 2022 and December 2022 for preoperative assessment in our centre. Exclusion criteria were neoadjuvant chemotherapy, and when a pathological analysis of the surgical specimen was not available. Enhancing NAC were considered infiltrated with both techniques. We calculated and compared CEM and MRI sensitivity, specificity, PPV, and NPV for the infiltration of NAC, considering the surgical specimen as the standard of reference. The statistical significance level used was P<0.05.
Results or Findings: After assessment of 168 MRI and 146 CEM, we included 109 MRI and 108 CEM. 23 MRI-patients and 13 CEM-patients had NAC infiltration at pathological analysis. Contrast enhancement of NAC was detected in 28/109 MRI and 15/108 CEM. The sensitivity, specificity, PPV, and NPV of MRI versus CEM were 92% (C.I. 74-99%), 94.05% (C.I. 87-98%), 82.14% (C.I. 66-92%), 97.53% (C.I. 91-99%) versus 92.86% (C.I. 66-99%), 97.87% (C.I. 93-99%), 86.67% (C.I. 62-96%), and 98.92% (C.I. 93-99%) respectively. Differences among MRI and CEM were not statistically significant with sensitivity Δ=0.860%, p=0.812; specificity Δ=3.820%; p=0.154; PPV Δ=4.530%; p=0.359, and NPV Δ=1.390%; p=0.439.
Conclusion: CEM seems to be as reliable as MRI in the assessment of infiltration of NAC.
Limitations: The study was monocentric and retrospective, with a limited number of patients.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.

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