Houben Ivo Pl, Vanwetswinkel S, Kalia V, Thywissen T, Nelemans P J, Heuts E M, Smidt M L, Meyer-Baese A, Wildberger J E, Lobbes Mbi
1 Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
2 Department of Radiodiagnosis, Sjúkrahúsið Akureyri, Iceland.
Acta Radiol. 2019 Sep;60(9):1110-1117. doi: 10.1177/0284185118822639. Epub 2019 Jan 24.
Detecting pathological breast calcifications remains challenging. Based on recent studies, contrast-enhanced spectral mammography (CESM) was shown to be superior compared to full-field digital mammography (FFDM).
To evaluate the diagnostic accuracy of CESM in suspicious breast calcifications and its impact on surgical decision-making.
All screening recalled patients with suspicious calcifications that underwent CESM in the period October 2012 until September 2015 were included. One experienced radiologist provided a BI-RADS classification for the FFDM images only. The evaluation was repeated for the CESM exam. In a simulated tumor board meeting, two breast surgeons decided on the preferred surgical treatment (breast conservation therapy [BCT] versus mastectomy) for all malignant cases. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated defining BI-RADS ≥4 as being malignant. In addition, differences in surgical decision-making were analyzed and compared using McNemar’s test.
In total, 147 women were included in this study (mean age = 61 years; age range = 49–75 years). Pathology showed 82 benign and 65 malignant lesions, of which 33 were ductal carcinomas in situ and 32 were invasive lesions. Diagnostic performances of CESM (differences compared to FFDM in brackets) were: sensitivity 93.8% (+3%), specificity 36.6% (−2.5%), PPV 54% (0%), and NPV 88.2% (+4%). Based on low-energy images, surgeons suggested BCT in 89% of the cases. Based on the CESM exam, no statistical changes in decisions were observed (86% BCT, = 0.453).
CESM only slightly improves the diagnostic accuracy of the evaluation of breast calcifications. It is not of added value compared to FFDM in guiding surgical decision-making.
检测病理性乳腺钙化仍然具有挑战性。基于最近的研究,对比增强光谱乳腺摄影(CESM)已被证明比全视野数字化乳腺摄影(FFDM)更具优势。
评估CESM对可疑乳腺钙化的诊断准确性及其对手术决策的影响。
纳入2012年10月至2015年9月期间所有接受CESM检查且筛查召回的可疑钙化患者。一名经验丰富的放射科医生仅对FFDM图像进行BI-RADS分类。对CESM检查重复进行评估。在模拟肿瘤病例讨论会上,两名乳腺外科医生针对所有恶性病例决定首选的手术治疗方式(保乳治疗[BCT]与乳房切除术)。计算敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV),将BI-RADS≥4定义为恶性。此外,使用McNemar检验分析和比较手术决策的差异。
本研究共纳入147名女性(平均年龄=61岁;年龄范围=49-75岁)。病理显示82例良性病变和65例恶性病变,其中33例为导管原位癌,32例为浸润性病变。CESM的诊断性能(与FFDM相比的差异列于括号内)为:敏感性93.8%(+3%),特异性36.6%(-2.5%),PPV 54%(0%),NPV 88.2%(+4%)。基于低能量图像,外科医生在89%的病例中建议进行BCT。基于CESM检查,未观察到决策有统计学变化(86%进行BCT,P=0.453)。
CESM仅略微提高了乳腺钙化评估的诊断准确性。在指导手术决策方面,与FFDM相比它并无附加价值。