Sudhir Rashmi, Sannapareddy Kamala, Potlapalli Alekya, Krishnamurthy Pooja Boggaram, Buddha Suryakala, Koppula Veeraiah
Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
Br J Radiol. 2021 Feb 1;94(1118):20201046. doi: 10.1259/bjr.20201046. Epub 2020 Dec 2.
To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard.
It was a prospective study, where consecutive females presenting to symptomatic breast clinic between April 2019 and June 2020 were evaluated with DBT. Females who were found to have heterogeneously dense (ACR type C) or extremely dense (ACR type D) breast composition detected on s2D MG were further evaluated with high-resolution breast ultrasound and thereafter with CEDM, but before the core biopsy or surgical excision, were included in the study. s2D MG was derived from post-processing reconstruction of DBT data set. Females with pregnancy, renal insufficiency or prior allergic reaction to iodinated contrast agent were excluded from the study. Image interpretation was done by two experienced breast radiologists and both were blinded to histological diagnosis.
This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24-72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, < 0.0001), DBT alone (82.8%, < 0.0001) and DBT + ultrasound (88.5%, = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, = 0.0002) and comparable to DBT alone (84.4%, = 0.3586) and DBT + ultrasound (79.7%, = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG.
CEDM is an accurate diagnostic technique for cancer detection in dense breast. CEDM allowed a significantly higher number of breast cancer detection than the s2D MG, DBT alone and DBT supplemented with ultrasonography in females with dense breast.
CEDM is a promising novel technology with higher sensitivity and negative predictive value for breast cancer detection in females with dense breast in comparison to DBT alone or DBT supplemented with ultrasound.
以组织病理学为金标准，评估对比增强数字化乳腺摄影（CEDM）与合成二维乳腺摄影（s2D MG）、单纯数字乳腺断层摄影（DBT）以及DBT联合超声检查相比，在致密型乳腺女性乳腺癌检测中的诊断效能。
这是一项前瞻性研究，对2019年4月至2020年6月期间因有症状就诊于乳腺专科门诊的连续女性患者进行DBT评估。在s2D MG上检测到乳腺组织为不均匀致密（ACR C型）或极度致密（ACR D型）的女性，进一步接受高分辨率乳腺超声检查，之后进行CEDM检查，但在核心活检或手术切除之前纳入本研究。s2D MG源自DBT数据集的后处理重建。妊娠、肾功能不全或既往对碘化造影剂过敏的女性被排除在研究之外。由两名经验丰富的乳腺放射科医生进行图像解读，且两人均对组织学诊断不知情。
本研究纳入了130例患者的166个乳腺病变，平均年龄为45±12岁（年龄范围24 - 72岁）。其中恶性病变87个（52.4%），良性病变79个（47.6%）。CEDM的敏感性为96.5%，显著高于合成二维乳腺摄影（75.6%，P<0.0001）、单纯DBT（82.8%，P<0.0001）以及DBT +超声检查（88.5%，P = 0.0057）；CEDM的特异性为81%，显著高于s2D MG（63.3%，P = 0.0002），与单纯DBT（84.4%，P = 0.3586）及DBT +超声检查（79.7%，P = 0.4135）相当。在受试者工作特征曲线分析中，CEDM的曲线下面积为0.896，DBT +超声检查为0.841，单纯DBT为0.769，s2D MG为0.729。
CEDM是致密型乳腺癌症检测的一种准确诊断技术。与s2D MG、单纯DBT以及DBT联合超声检查相比，CEDM在致密型乳腺女性中能检测出显著更多的乳腺癌。
与单纯DBT或DBT联合超声检查相比，CEDM是一项有前景的新技术，在致密型乳腺女性乳腺癌检测中具有更高的敏感性和阴性预测价值。
