Helal Maha Hussien, Mansour Sahar Mahmoud, Salaleldin Lamia Adel, Alkalaawy Basma Mohamed, Salem Dorria Saleh, Mokhtar Nadia Mahmoud
1 Department of Radiology, Women's Imaging Unit, National Cancer Institute, Cairo University , Cairo , Egypt.
2 Department of Radiology, Women's Imaging Unit, Kasr-El Ainy Hospital, Cairo University , Cairo , Egypt.
Br J Radiol. 2018 Jul;91(1087):20170977. doi: 10.1259/bjr.20170977. Epub 2018 May 24.
The main importance of imaging breast cancer is to guide conservative surgeries. In this study, we evaluated the role of contrast-enhanced spectral mammogram (CESM) in correlation with three-dimensional (3D) breast ultrasound in characterizing the extension of the intramammary cancer in view of the: (i) the size of the main tumor, (ii) the multiplicity of the breast cancer, and (iii) the peri-tumoral stromal involvement (i.e. free or intraductal extension of the cancer).
The study is a prospective analysis that included 300 breast masses proved to be malignant. The masses were evaluated for their size, multiplicity and surrounding stromal involvement. Contrast-based mammography performed with low (22-33 kVp) and high (44-49 kVp) energy exposures that were taken after i.v. injection of contrast agent and followed by bilateral 3D breast ultrasound. Operative data were the gold standard reference.
There was no significant difference between the sizes of the included cancers as measured by CESM and 3D ultrasound and that measured at the pathological analysis. CESM showed higher accuracy (32.7%, n = 98) than 3D ultrasound (24.7%, n = 74) in the size agreement within 5% range. CESM was the most accurate modality (94%, n = 282) in detecting tumor multiplicity, followed by traditional sonomammogram (88%, n = 264), then 3D breast ultrasound (84%, n = 252). Intraductal extension of the breast cancer was best evaluated by the 3D ultrasound with an accuracy value of 98% (n = 294) compared to only 60% (n = 180) by CESM.
CESM is a recommended investigation in breast cancer to increase the accuracy of size measurement and the detection of multiple tumors. The addition of 3D ultrasound can enhance the detection of intraductal extension. Advances in knowledge: Choice of conservative breast surgery vs mastectomy is still a debate. We used an advanced, contrast-based, application of the mammogram: CESM and a non-invasive 3D breast ultrasound in the assessment of the local extension of the breast cancer regarding size, perifocal stromal infiltration and multiplicity to guide the selection of proper management in proved cases of breast cancer.
乳腺影像检查的主要意义在于指导保乳手术。在本研究中，我们评估了对比增强光谱乳腺摄影（CESM）与三维（3D）乳腺超声联合应用在确定乳腺内癌灶范围方面的作用，具体涉及：（i）主瘤大小；（ii）乳腺癌的多灶性；（iii）瘤周间质受累情况（即癌灶的游离或导管内扩展）。
本研究为前瞻性分析，纳入300例经证实为恶性的乳腺肿块。评估这些肿块的大小、多灶性及周围间质受累情况。静脉注射造影剂后，分别采用低能量（22 - 33 kVp）和高能量（44 - 49 kVp）曝光进行对比乳腺摄影，随后进行双侧3D乳腺超声检查。手术数据作为金标准参考。
CESM和3D超声测量的纳入癌灶大小与病理分析测量的大小之间无显著差异。在大小一致性处于5%范围内时，CESM的准确率（32.7%，n = 98）高于3D超声（24.7%，n = 74）。CESM在检测肿瘤多灶性方面是最准确的检查方式（94%，n = 282），其次是传统乳腺超声（88%，n = 264），然后是3D乳腺超声（84%，n = 252）。与CESM仅60%（n = 180）的准确率相比，3D超声评估乳腺癌导管内扩展的准确率最高，为98%（n = 294）。
CESM是乳腺癌推荐的检查方法，可提高大小测量及多灶性肿瘤检测的准确性。联合3D超声可提高导管内扩展的检测率。知识进展：保乳手术与乳房切除术的选择仍存在争议。我们采用了先进的基于对比的乳腺摄影应用：CESM和无创的3D乳腺超声来评估乳腺癌在大小、瘤周间质浸润及多灶性方面的局部扩展情况，以指导确诊乳腺癌病例的恰当治疗选择。
