SCDU Radiodiagnostica, Ospedale Maggiore Della Carità, 28100, Novara, Italy.
Dipartimento Di Medicina Translazionale, Università del Piemonte Orientale, 28100, Novara, Italy.
Radiol Med. 2024 Jul;129(7):989-998. doi: 10.1007/s11547-024-01838-3. Epub 2024 Jul 10.
Contrast-enhanced mammography (CEM) is an innovative imaging tool for breast cancer detection, involving intravenous injection of a contrast medium and the assessment of lesion enhancement in two phases: early and delayed. The aim of the study was to analyze the topographic concordance of lesions detected in the early- versus delayed phase acquisitions.
Approved by the Ethics Committee (No. 118/20), this prospective study included 100 women with histopathological confirmed breast neoplasia (B6) at the Radiodiagnostics Department of the Maggiore della Carità Hospital of Novara, Italy from May 1, 2021, to October 17, 2022. Participants underwent CEM examinations using a complete protocol, encompassing both early- and delayed image acquisitions. Three experienced radiologists blindly analyzed the CEM images for contrast enhancement to determine the topographic concordance of the identified lesions. Two readers assessed the complete study (protocol A), while one reader assessed the protocol without the delayed phase (protocol B). The average glandular dose (AGD) of the entire procedure was also evaluated.
The analysis demonstrated high concordance among the three readers in the topographical identification of lesions within individual quadrants of both breasts, with a Cohen's κ > 0.75, except for the lower inner quadrant of the right breast and the retro-areolar region of the left breast. The mean whole AGD was 29.2 mGy. The mean AGD due to CEM amounted to 73% of the whole AGD (21.2 mGy). The AGD attributable to the delayed phase of CEM contributed to 36% of the whole AGD (10.5 mGy).
As we found no significant discrepancy between the readings of the two protocols, we conclude that delayed-phase image acquisition in CEM does not provide essential diagnostic benefits for effective disease management. Instead, it contributes to unnecessary radiation exposure.
对比增强乳腺摄影（CEM）是一种用于乳腺癌检测的创新成像工具，包括静脉内注射造影剂，并在早期和延迟两个阶段评估病变增强情况。本研究旨在分析早期和延迟采集获得的病变在影像学上的一致性。
本前瞻性研究于 2021 年 5 月 1 日至 2022 年 10 月 17 日在意大利诺瓦拉马焦雷慈善医院放射科进行，共纳入 100 名经组织病理学证实患有乳腺肿瘤（B6）的女性。该研究获得了伦理委员会的批准（编号 118/20）。参与者接受了完整的 CEM 检查方案，包括早期和延迟图像采集。三名经验丰富的放射科医生对 CEM 图像进行了增强分析，以确定所识别病变的影像学位置一致性。两位读者评估了完整的研究（方案 A），而一位读者评估了没有延迟期的方案（方案 B）。还评估了整个过程的平均腺体剂量（AGD）。
三位读者在单独评估双侧乳房各象限的病变位置时，除了右乳下内象限和左乳乳晕后区域外，其余病变的κ 值均>0.75，具有高度一致性。整个过程的平均 AGD 为 29.2 mGy。CEM 的平均 AGD 占整个 AGD 的 73%（21.2 mGy）。CEM 延迟期的 AGD 占整个 AGD 的 36%（10.5 mGy）。
由于我们在两个方案的阅读结果之间未发现明显差异，因此我们得出结论，CEM 的延迟期图像采集对于有效的疾病管理并没有提供重要的诊断益处。相反，它会导致不必要的辐射暴露。
