Bozzini Anna, Nicosia Luca, Pruneri Giancarlo, Maisonneuve Patrick, Meneghetti Lorenza, Renne Giuseppe, Vingiani Andrea, Cassano Enrico, Mastropasqua Mauro Giuseppe
Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141, Milan, Italy.
School of Medicine, University of Milan, Milan, Italy.
Breast Cancer Res Treat. 2020 Dec;184(3):723-731. doi: 10.1007/s10549-020-05881-2. Epub 2020 Aug 28.
To compare the efficacy of contrast-enhanced spectral mammography, with ultrasound, full field digital mammography and magnetic resonance imaging in detection and size estimation of histologically proven breast tumors.
This open-label, single center, prospective study, included 160 dense breast women with at least one suspicious mammary lesion evaluated by ultrasound, full field digital mammography and magnetic resonance imaging in whom a mammary tumor was histologically proven after surgery performed at the European Institute of Oncology between January 2013 and December 2015. Following the complete diagnostic procedure, the patients were further investigated by contrast-enhanced spectral mammography prior to surgery.
Overall, the detection rate of malignant breast lesions (in situ and invasive) was 93.8% (165/176) for contrast-enhanced spectral mammography, 94.4% (168/178) for ultrasound, 85.5 (147/172) for full field digital mammography and 97.7% (173/177) for magnetic resonance imaging. Radiological measurements were concordant with the post-surgical pathological measurements of the invasive tumor (i.e., within 5 mm) in: 64.6% for contrast-enhanced spectral mammography, 62.0% for ultrasound, 45.2% for full field digital mammography (p < 0.0001) and 69.9% for magnetic resonance imaging (p = 0.28); underestimated in: 17.4% for contrast-enhanced spectral mammography, 19.6% for ultrasound, 24.2% for full field digital mammography (p = 0.03) and 6.7% for magnetic resonance imaging (p = 0.0005); and overestimated in: 16.2% for contrast-enhanced spectral mammography, 16.6% for ultrasound, 16.6% for full field digital mammography and 22.7% for magnetic resonance imaging (p = 0.02).
Our data suggest that contrast-enhanced spectral mammography improves on full field digital mammography and is comparable to ultrasound and magnetic resonance imaging in terms of detection sensitivity and size estimation of malignant lesions in dense breasts.
比较对比增强光谱乳腺摄影与超声、全视野数字化乳腺摄影及磁共振成像在组织学确诊的乳腺肿瘤检测及大小估计方面的疗效。
本开放标签、单中心前瞻性研究纳入了160名乳腺致密的女性，她们至少有一个可疑乳腺病变，均接受了超声、全视野数字化乳腺摄影及磁共振成像检查，并于2013年1月至2015年12月在欧洲肿瘤研究所接受手术，术后经组织学证实为乳腺肿瘤。在完成完整的诊断程序后，患者在手术前进一步接受对比增强光谱乳腺摄影检查。
总体而言，对比增强光谱乳腺摄影对恶性乳腺病变（原位和浸润性）的检出率为93.8%（165/176），超声为94.4%（168/178），全视野数字化乳腺摄影为85.5%（147/172），磁共振成像为97.7%（173/177）。对比增强光谱乳腺摄影对浸润性肿瘤的放射学测量与术后病理测量结果相符（即相差在5毫米以内）的比例为64.6%，超声为62.0%，全视野数字化乳腺摄影为45.2%（p<0.0001），磁共振成像为69.9%（p=0.28）；对比增强光谱乳腺摄影低估肿瘤大小的比例为17.4%，超声为19.6%，全视野数字化乳腺摄影为24.2%（p=0.03），磁共振成像为6.7%（p=0.0005）；对比增强光谱乳腺摄影高估肿瘤大小的比例为16.2%，超声为16.6%，全视野数字化乳腺摄影为16.6%，磁共振成像为22.7%（p=0.02）。
我们的数据表明，对比增强光谱乳腺摄影在全视野数字化乳腺摄影的基础上有所改进，在致密乳腺中恶性病变的检测敏感性和大小估计方面与超声及磁共振成像相当。
