Popat Palak, Nandi Venugopal Prudveesh Kumar Reddy, Katdare Aparna, Haria Purvi, Thakur Meenakshi, Kulkarni Suyash
Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, IND.
Cureus. 2024 Sep 4;16(9):e68601. doi: 10.7759/cureus.68601. eCollection 2024 Sep.
To assess the diagnostic accuracy and incremental value of contrast-enhanced mammography (CEM) compared with full-field digital mammography (FFDM).
A retrospective analysis was performed with 150 consecutive patients who underwent CEM at our institute between November 2020 and February 2021, fulfilling the inclusion criteria. The first round of analysis included a review of FFDM with an interpretation of findings as per the Breast Imaging Reporting and Data System (BIRADS) lexicon and the assignment of the BIRADS category to the detected abnormalities. After this documentation, a second round of analysis included a review of recombined subtracted images of CEM. The diagnostic accuracy of FFDM and CEM was calculated with histopathology as the gold standard.
Among the 150 cases assessed, 202 lesions were detected with histopathological correlation, of which 42 were benign and 160 were malignant. The sensitivity of FFDM was 90.6% compared to 98.12% for CEM. The specificity of FFDM was 66.7% compared to 76.19% for CEM. The negative predictive value (NPV) of FFDM was low, at 65.12%; CEM showed a better NPV, at 91.43%. The positive predictive value (PPV) was almost the same, at 94.01% for CEM and 91.19% for FFDM. The area under the curve (AUC) was superior for CEM compared to that of FFDM, with a value of 0.87. FFDM had a low sensitivity, especially in dense breast parenchyma, at 88.79% and a specificity of 70%, whereas CEM showed a higher sensitivity, specificity, and NPV, measuring 99.14%, 76.67%, and 95.83%, respectively.
Superior sensitivity and high NPV for CEM make it a preferable modality compared with FFDM, especially in dense breast parenchyma, where CEM overcomes the limitations of FFDM. We conclude that CEM is superior to FFDM in evaluating the extent of disease, additional satellite lesion detection, and ruling out ambiguous findings.
评估对比增强乳腺钼靶摄影（CEM）与全视野数字乳腺钼靶摄影（FFDM）相比的诊断准确性和增量价值。
对2020年11月至2021年2月期间在我院接受CEM检查且符合纳入标准的150例连续患者进行回顾性分析。第一轮分析包括对FFDM的回顾，并根据乳腺影像报告和数据系统（BIRADS）词典对检查结果进行解读，以及为检测到的异常指定BIRADS类别。在完成此记录后，第二轮分析包括对CEM重组减影图像的回顾。以组织病理学为金标准计算FFDM和CEM的诊断准确性。
在评估的150例病例中，通过组织病理学相关性检测到202个病变，其中42个为良性，160个为恶性。FFDM的敏感性为90.6%，而CEM为98.12%。FFDM的特异性为66.7%，而CEM为76.19%。FFDM的阴性预测值（NPV）较低，为65.12%；CEM的NPV较好，为91.43%。阳性预测值（PPV）几乎相同，CEM为94.01%，FFDM为91.19%。与FFDM相比，CEM的曲线下面积（AUC）更高，值为0.87。FFDM敏感性较低，尤其是在致密乳腺实质中，敏感性为88.79%，特异性为70%，而CEM显示出更高的敏感性、特异性和NPV，分别为99.14%、76.67%和95.83%。
CEM具有更高的敏感性和较高的NPV，使其成为比FFDM更优的检查方式，尤其是在致密乳腺实质中，CEM克服了FFDM的局限性。我们得出结论，在评估疾病范围、检测额外的卫星病灶以及排除模糊的检查结果方面，CEM优于FFDM。
