Ong Ann-Hui Jamie, Goh Yonggeng, Quek Swee Tian, Pillay Premilla Gopinathan, Lee Herng-Sheng, Chou Chen-Pin
Department of Diagnostic Imaging, National University Hospital, Singapore 119074, Singapore.
Department of Pathology and Laboratory Medicine, Kaoshiung Veterans General Hospital, Kaoshiung 813, Taiwan.
Diagnostics (Basel). 2024 Oct 16;14(20):2297. doi: 10.3390/diagnostics14202297.
To assess the efficacy of contrast-enhanced mammography (CEM) in differentiating benign from malignant breast lesions in Asian patients with bloody nipple discharge (BND).
This retrospective study included 58 women with BND (mean age: 51.7 years) who underwent standardized CEM at institutions in Taiwan and Singapore. Lesion characteristics (size, enhancement, conspicuity, shape, margins) were evaluated on CEM by blinded radiologists. Non-enhanced mammography (MMG) and ultrasound (US) within a defined timeframe were compared for diagnostic accuracy. Benign or malignant status was confirmed by biopsy or 2-year imaging follow-up.
Malignancy was found in 29 of 58 lesions (50.0%), with ductal carcinoma in situ (DCIS) being the most common. CEM demonstrated a 100% negative predictive value (NPV) for non-enhancing lesions. Significant predictors of malignancy on multivariate analysis include enhancing lesions of size ≥ 1.5 cm (-value 0.025) and suspicious morphological features (irregular/spiculated margins, irregular shape, segmental/linear NME distribution) (-value < 0.001). CEM outperformed MMG (sensitivity: 58.6%) and US (sensitivity: 79.3%), achieving a sensitivity of 100% and the highest diagnostic accuracy at 81.3%. Additionally, a CEM size cut-off of 1.5 cm yielded a sensitivity of 73.5% and a specificity of 84.3%.
CEM effectively differentiates benign from malignant lesions in patients with BND, improving diagnostic accuracy and potentially reducing unnecessary interventions.
评估对比增强乳腺钼靶摄影（CEM）在鉴别亚洲血性乳头溢液（BND）患者乳腺良恶性病变中的疗效。
这项回顾性研究纳入了58例BND患者（平均年龄：51.7岁），这些患者在台湾和新加坡的机构接受了标准化CEM检查。由不知情的放射科医生在CEM上评估病变特征（大小、强化、清晰度、形状、边缘）。比较在规定时间内的非增强乳腺钼靶摄影（MMG）和超声（US）的诊断准确性。通过活检或2年的影像随访确定良性或恶性状态。
58个病变中有29个（50.0%）为恶性，其中原位导管癌（DCIS）最为常见。CEM对无强化病变的阴性预测值（NPV）为100%。多因素分析中，恶性的显著预测因素包括大小≥1.5 cm的强化病变（P值0.025）和可疑的形态学特征（边缘不规则/毛刺状、形状不规则、节段性/线性非肿块强化分布）（P值<0.001）。CEM的表现优于MMG（敏感性：58.6%）和US（敏感性：79.3%），敏感性达到100%，诊断准确性最高，为81.3%。此外，CEM大小截断值为1.5 cm时，敏感性为73.5%，特异性为84.3%。
CEM能有效鉴别BND患者的乳腺良恶性病变，提高诊断准确性，并可能减少不必要的干预。
