Cheung Yun-Chung, Juan Yu-Hsiang, Lin Yu-Ching, Lo Yung-Feng, Tsai Hsiu-Pei, Ueng Shir-Hwa, Chen Shin-Cheh
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Medical College of Chang Gung University, 5 Fuxing Street, Guishan Township, Taoyuan County, Taoyuan, Taiwan.
PLoS One. 2016 Sep 9;11(9):e0162740. doi: 10.1371/journal.pone.0162740. eCollection 2016.
Mammography screening is a cost-efficient modality with high sensitivity for detecting impalpable cancer with microcalcifications, and results in reduced mortality rates. However, the probability of finding microcalcifications without associated cancerous masses varies. We retrospectively evaluated the diagnosis and cancer probability of the non-mass screened microcalcifications by dual-energy contrast-enhanced spectral mammography (DE-CESM).
With ethical approval from our hospital, we enrolled the cases of DE-CESM for analysis under the following inclusion criteria: (1) referrals due to screened BI-RADS 4 microcalcifications; (2) having DE-CESM prior to stereotactic biopsy; (3) no associated mass found by sonography and physical examination; and (4) pathology-based diagnosis using stereotactic vacuum-assisted breast biopsy. We analyzed the added value of post-contrast enhancement on DE-CESM.
A total of 94 biopsed lesions were available for analysis in our 87 women, yielding 27 cancers [19 ductal carcinoma in situ (DCIS), and 8 invasive ductal carcinoma (IDC)], 32 pre-malignant and 35 benign lesions. Of these 94 lesions, 33 showed associated enhancement in DE-CESM while the other 61 did not. All 8 IDC (100%) and 16 of 19 DCIS (84.21%) showed enhancement, but the other 3 DCIS (15.79%) did not. Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 88.89%, 86.56%, 72.72%, 95.08% and 87.24%, respectively. The performances of DE-CESM on both amorphous and pleomorphic microcalcifications were satisfactory (AUC 0.8 and 0.92, respectively). The pleomorphous microcalcifications with enhancement showed higher positive predictive value (90.00% vs 46.15%, p = 0.013) and higher cancer probability than the amorphous microcalcifications (46.3% VS 15.1%). The Odds Ratio was 4.85 (95% CI: 1.84-12.82).
DE-CESM might provide added value in assessing the non-mass screened breast microcalcification, with enhancement favorable to the diagnosis of cancers or lack of enhancement virtually diagnostic for non-malignant lesions or noninvasive subgroup cancers.
乳腺钼靶筛查是一种具有成本效益的检查方式,对于检测伴有微钙化的不可触及性癌症具有高灵敏度,并能降低死亡率。然而,发现无相关癌性肿块的微钙化的概率各不相同。我们通过双能对比增强光谱乳腺摄影(DE-CESM)回顾性评估了非肿块型筛查微钙化的诊断及癌症概率。
经我院伦理批准,我们纳入符合以下纳入标准的DE-CESM病例进行分析:(1)因筛查出BI-RADS 4类微钙化而转诊;(2)在立体定向活检前进行了DE-CESM检查;(3)超声和体格检查未发现相关肿块;(4)采用立体定向真空辅助乳腺活检进行基于病理的诊断。我们分析了DE-CESM上对比剂增强后的附加值。
我们的87名女性中共有94个活检病变可供分析,其中有27例癌症[19例导管原位癌(DCIS)和8例浸润性导管癌(IDC)],32例癌前病变和35例良性病变。在这94个病变中,33个在DE-CESM上显示有相关增强,而另外61个没有。所有8例IDC(100%)和19例DCIS中的16例(84.21%)显示有增强,但另外3例DCIS(15.79%)没有。总体灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为88.89%、86.56%、72.72%、95.08%和87.24%。DE-CESM对无定形和多形性微钙化的表现均令人满意(曲线下面积分别为0.8和0.92)。有增强的多形性微钙化显示出更高的阳性预测值(90.00%对46.15%,p = 0.013),且癌症概率高于无定形微钙化(46.3%对15.1%)。优势比为4.85(95%置信区间:1.84 - 12.82)。
DE-CESM在评估非肿块型筛查乳腺微钙化方面可能具有附加值,增强有利于癌症诊断,而缺乏增强实际上可诊断为非恶性病变或非侵袭性亚组癌症。