Clauser Paola, Pötsch Nina, Santonocito Ambra, Ferrara Francesca, Zeitouni Layla, Hörnig Mathias, Weber Michael, Baltzer Pascal A T, Helbich Thomas H
From the Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria (P.C., N.P., A.S., M.W., P.A.T.B., T.H.H.); Catholic University of the Sacred Heart, Institute of Radiology, Rome, Italy (F.F.); Department of Radiology Section of Breast Imaging, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia (L.Z.); and Diagnostic Imaging, Siemens Healthcare GmbH, Forchheim, Germany (M.H.).
Invest Radiol. 2025 Jun 1;60(6):369-375. doi: 10.1097/RLI.0000000000001138. Epub 2024 Dec 2.
Contrast-enhanced mammography (CEM) is an accurate competitor for contrast-enhanced breast magnetic resonance imaging (CE-MRI), but the examination is limited by the lack of 3D information. Digital breast tomosynthesis (DBT) allows better lesion detection and characterization compared with mammography. The availability of quasi-3D contrast imaging could further improve the performance of CEM. The aim of our analysis was to compare the diagnostic performance of a contrast-enhanced digital breast tomosynthesis prototype (CE-DBTp) to CEM and to CE-MRI.
This prospective study was approved by the ethics committee, and all patients gave written informed consent. Women who presented with suspicious findings on mammography, DBT, or ultrasound were invited to participate in the study. Participants underwent CEM and CE-DBTp of the breast with the suspicious findings as well as bilateral CE-MRI. Histology was used as the standard of reference. Four readers (R1 and R2 non-experienced; R3 and R4 experienced) evaluated the images, blinded to patients' history, previous imaging, and histology. The readers evaluated CEM, CE-DBTp, and CE-MRI in separate sessions and gave a BI-RADS score for each finding. Sensitivity, specificity, lesion conspicuity, and readers' confidence were calculated and compared.
We included 84 patients (mean age, 56 years; range, 39-70) with 91 histologically verified breast lesions (27 benign, 64 malignant). The accuracy of the CE-DBTp was high, but significant differences were seen between experienced (both 86.8%) and non-experienced readers (76.9% and 78%, P = 0.021). No differences were found between CEM and CE-DBTp, whereas the accuracy of CE-MRI was higher ( P = 0.002). Sensitivity with CE-DBTp varied (89.1% to 100%) between experienced and non-experienced readers ( P = 0.074), and it was comparable to CEM but lower than CE-MRI ( P = 0.003). Specificity was variable between readers with all modalities. Lesion conspicuity was higher for the CE-DBTp and CE-MRI than for CEM, and confidence was significantly higher with the CE-DBTp than with CEM for one of the readers ( P < 0.001).
A high sensitivity and good accuracy were achieved with the CE-DBTp. Lesion conspicuity and readers' confidence were higher with the CE-DBTp compared with CEM. However, CE-MRI had the highest sensitivity and accuracy.
对比增强乳腺钼靶摄影（CEM）是对比增强乳腺磁共振成像（CE-MRI）的有力竞争对手，但该检查受限于缺乏三维信息。与乳腺钼靶摄影相比，数字乳腺断层合成（DBT）能更好地检测和鉴别病变。准三维对比成像的应用可进一步提高CEM的性能。我们分析的目的是比较对比增强数字乳腺断层合成原型（CE-DBTp）与CEM及CE-MRI的诊断性能。
本前瞻性研究经伦理委员会批准，所有患者均签署了书面知情同意书。邀请在乳腺钼靶摄影、DBT或超声检查中发现可疑结果的女性参与研究。参与者对有可疑结果的乳房进行CEM和CE-DBTp检查以及双侧CE-MRI检查。组织学检查作为参考标准。四位阅片者（R1和R2为非经验丰富者；R3和R4为经验丰富者）在不了解患者病史、既往影像检查及组织学结果的情况下对图像进行评估。阅片者在不同时间段分别评估CEM、CE-DBTp和CE-MRI，并对每个发现给出乳腺影像报告和数据系统（BI-RADS）评分。计算并比较敏感度、特异度、病变清晰度及阅片者的信心度。
我们纳入了84例患者（平均年龄56岁；范围39 - 70岁），有91个经组织学证实的乳腺病变（27个良性，64个恶性）。CE-DBTp的准确性较高，但经验丰富的阅片者（均为86.8%）与非经验丰富的阅片者（76.9%和78%）之间存在显著差异（P = 0.021）。CEM与CE-DBTp之间未发现差异，而CE-MRI的准确性更高（P = 0.002）。经验丰富与非经验丰富的阅片者对CE-DBTp的敏感度有所不同（89.1%至100%）（P = 0.074），其与CEM相当，但低于CE-MRI（P = 0.003）。所有检查方式在不同阅片者之间的特异度各不相同。CE-DBTp和CE-MRI的病变清晰度高于CEM，且对于其中一位阅片者而言，CE-DBTp的信心度显著高于CEM（P < 0.001）。
CE-DBTp具有较高的敏感度和良好的准确性。与CEM相比，CE-DBTp的病变清晰度和阅片者信心度更高。然而，CE-MRI的敏感度和准确性最高。
Zotero 插件