Helal Maha H, Mansour Sahar M, Zaglol Mai, Salaleldin Lamia A, Nada Omniya M, Haggag Marwa A
1 Women's Imaging Unit, Department of Radiology, National Cancer Institute, Cairo University, Egypt.
2 Women's Imaging Unit, Department of Radiology, Kasr El Ainy Hospital, Cairo University, Egypt.
Br J Radiol. 2017 Mar;90(1071):20160717. doi: 10.1259/bjr.20160717. Epub 2017 Feb 22.
To study the role of advanced applications of digital mammogram, whether contrast-enhanced spectral mammography (CESM) or digital breast tomosynthesis (DBT), in the "T" staging of histologically proven breast cancer before planning for treatment management.
In this prospective analysis, we evaluated 98 proved malignant breast masses regarding their size, multiplicity and the presence of associated clusters of microcalcifications. Evaluation methods included digital mammography (DM), 3D tomosynthesis and CESM. Traditional DM was first performed then in a period of 10-14-day interval; breast tomosynthesis and contrast-based mammography were performed for the involved breast only. Views at tomosynthesis were acquired in a "step-and-shoot" tube motion mode to produce multiple (11-15), low-dose images and in contrast-enhanced study, low-energy (22-33 kVp) and high-energy (44-49 kVp) exposures were taken after the i.v. injection of the contrast agent. Operative data were the gold standard reference.
Breast tomosynthesis showed the highest accuracy in size assessment (n = 69, 70.4%) than contrast-enhanced (n = 49, 50%) and regular mammography (n = 59, 60.2%). Contrast-enhanced mammography presented the least performance in assessing calcifications, yet it was most sensitive in the detection of multiplicity (92.3%), followed by tomosynthesis (77%) and regular mammography (53.8%). The combined analysis of the three modalities provided an accuracy of 74% in the "T" staging of breast cancer.
The combined application of tomosynthesis and contrast-enhanced digital mammogram enhanced the performance of the traditional DM and presented an informative method in the staging of breast cancer. Advances in knowledge: Staging and management planning of breast cancer can divert according to tumour size, multiplicity and the presence of microcalcifications. DBT shows sharp outlines of the tumour with no overlap tissue and spots microcalcifications. Contrast-enhanced spectral mammogram shows the extent of abnormal contrast uptake and detects multiplicity. Integrated analysis provides optimal findings for proper "T" staging of breast cancer.
研究数字乳腺摄影的高级应用，即对比增强光谱乳腺摄影（CESM）或数字乳腺断层合成（DBT）在组织学确诊的乳腺癌治疗前“T”分期中的作用。
在这项前瞻性分析中，我们评估了98个已证实为恶性的乳腺肿块的大小、数量以及是否存在相关微钙化簇。评估方法包括数字乳腺摄影（DM）、三维断层合成和CESM。首先进行传统的DM检查，然后在10至14天的间隔期内；仅对患侧乳房进行乳腺断层合成和基于对比剂的乳腺摄影。断层合成的图像采集采用“步进-拍摄”管运动模式，以生成多个（11至15个）低剂量图像，在对比增强研究中，静脉注射对比剂后进行低能（22至33 kVp）和高能（44至49 kVp）曝光。手术数据为金标准参考。
乳腺断层合成在大小评估方面显示出最高的准确性（n = 69，70.4%），高于对比增强（n = 49，50%）和常规乳腺摄影（n = 59，60.2%）。对比增强乳腺摄影在评估钙化方面表现最差，但在检测肿块数量方面最敏感（92.3%），其次是断层合成（77%）和常规乳腺摄影（53.8%）。三种模式的联合分析在乳腺癌“T”分期中的准确率为74%。
断层合成和对比增强数字乳腺摄影的联合应用提高了传统DM的性能，并为乳腺癌分期提供了一种信息丰富的方法。知识进展：乳腺癌的分期和治疗计划可根据肿瘤大小、数量和微钙化的存在而有所不同。DBT显示肿瘤轮廓清晰，无重叠组织，并能发现微钙化。对比增强光谱乳腺摄影显示异常对比剂摄取的范围并检测肿块数量。综合分析为乳腺癌的正确“T”分期提供了最佳结果。
