Xu Weimin, Chen Lingjian, Zeng Weixiong, Xu Zeyuan, Ma Mengwei, Chen Weiguo, Liao Xin, Wen Chanjuan, Wang Sina
Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province 510515, China.
Department of Equipment, The First People's Hospital of Shunde, Southern Medical University, Shunde, Guangdong Province 528300, China.
Br J Radiol. 2025 Mar 1;98(1167):383-391. doi: 10.1093/bjr/tqae241.
To investigate the capability of morphological and enhancement pattern analysis in contrast-enhanced mammography (CEM) to differentiate between benign and malignant papillary breast lesions.
This study involved 63 patients diagnosed with papillary breast lesions between January 2018 and December 2022. CEM was performed at two time intervals: between 2-3 min (T1, early phase) and 4-5 min (T2, later phase) after the injection of the contrast agent. For each patient, Breast Imaging Reporting and Data System (BI-RADS) lesion features were recorded. Kinetic enhancement patterns were evaluated for both phases based on these changes, followed by the measurement of diagnostic performance.
Among the 63 female patients, a total of 86 lesions were identified, including 18 malignant ones, three intraductal papillomas without atypical proliferation, and 42 benign papillary lesions. The areas under receiver operating characteristic curves for CEM with kinetic enhancement and for CEM alone were 0.856 and 0.800, respectively. Assessing the diagnostic value, specificity, and accuracy of morphological categorization combined with kinetic enhancement showed higher values compared to those of the CEM morphological categorization alone (71.1% vs 60.0% and 79.4% vs 71.4%, respectively). However, the sensitivity and negative predictive value of the CEM with kinetic enhancement were similar to those of CEM alone (100% for all).
For BI-RADS 3-5 papillary breast lesions, incorporating CEM kinetic enhancement to morphological patterns improved the confidence level in diagnosis.
This article provides valuable references for distinguishing benign and malignant breast papillary lesions.
探讨对比增强乳腺钼靶摄影（CEM）中形态学及强化模式分析对鉴别乳腺乳头状病变良恶性的能力。
本研究纳入了2018年1月至2022年12月期间诊断为乳腺乳头状病变的63例患者。在注射造影剂后的两个时间点进行CEM检查：注射后2 - 3分钟（T1，早期）和4 - 5分钟（T2，晚期）。记录每位患者的乳腺影像报告和数据系统（BI-RADS）病变特征。根据这些变化评估两个阶段的动态强化模式，随后测量诊断性能。
63例女性患者共发现86个病变，其中恶性病变18个，3例无非典型增生的导管内乳头状瘤，42例良性乳头状病变。动态强化CEM及单纯CEM的受试者操作特征曲线下面积分别为0.856和0.800。与单纯CEM形态学分类相比，形态学分类结合动态强化评估诊断价值、特异性和准确性显示出更高的值（分别为71.1%对60.0%和79.4%对71.4%）。然而，动态强化CEM的敏感性和阴性预测值与单纯CEM相似（均为100%）。
对于BI-RADS 3 - 5级乳腺乳头状病变，将CEM动态强化纳入形态学模式可提高诊断的置信度。
本文为鉴别乳腺乳头状病变的良恶性提供了有价值的参考。
