Bicchierai Giulia, Migliaro Giuliano, Pugliese Francesca, Amato Francesco, De Benedetto Diego, Vanzi Ermanno, Di Naro Federica, Boeri Cecilia, Bellini Chiara, Vidali Sofia, Toncelli Kassandra, Bianchi Simonetta, Orzalesi Lorenzo, Miele Vittorio, Nori Jacopo
Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
Radiology Department, Ospedale San Giovanni Di Dio, Agrigento, Italy.
Radiol Med. 2025 Mar 28. doi: 10.1007/s11547-025-02009-8.
The purpose of this study was to assess the diagnostic performance of CEM in the preoperative staging of breast cancer in a large cohort of patients.
A retrospective review of preoperative staging CEM exams was conducted at our centre between June 2016 and June 2021. We evaluated cases where CEM influenced the type of surgery, necessitated additional biopsies or imaging, and identified additional lesions. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of CEM for the entire sample and each subgroup setting were calculated. A receiver operating characteristic (ROC) curve and multivariate analysis were performed.
991 women, mean age 61.3 years old [35-93], with 1005 malignant lesions were included. CEM led to additional imaging in 36.7% (364/991) women and to additional biopsies in 18.5% (183/991) women. CEM altered the initial surgical plan based on conventional imaging in 226 out of 991 patients (22.8%). CEM had a sensitivity in the whole population of 91.5% (204/223), specificity of 96.8% (757/782), PPV of 89.1% (204/229), NPV of 97.5% (757/776) and an accuracy of 95.6% (961/1005); the AUC of the ROC curve was 0.941. We found CEM better performed in patients with a low BPE level compared with a high BPE level (ρ = 0.028861). We see that the presence of additional lesions at CEM was the only significant predictor in the model.
This study reaffirms the high diagnostic accuracy of CEM for preoperative breast cancer staging in a large patient cohort.
本研究旨在评估对比增强乳腺钼靶（CEM）在一大群患者乳腺癌术前分期中的诊断性能。
2016年6月至2021年6月在我们中心对术前分期的CEM检查进行了回顾性研究。我们评估了CEM影响手术类型、需要额外活检或影像学检查以及发现额外病变的病例。计算了CEM对整个样本以及每个亚组设置的敏感性、特异性、阳性和阴性预测值（PPV和NPV）以及准确性。绘制了受试者工作特征（ROC）曲线并进行了多变量分析。
纳入了991名女性患者（平均年龄61.3岁[35 - 93岁]），共1005个恶性病变。CEM导致36.7%（364/991）的女性患者需要额外影像学检查，18.5%（183/991）的女性患者需要额外活检。CEM改变了991例患者中226例（22.8%）基于传统影像学的初始手术计划。CEM在总体人群中的敏感性为91.5%（204/223），特异性为96.8%（757/782），PPV为89.1%（204/229），NPV为97.5%（757/776），准确性为95.6%（961/1005）；ROC曲线的AUC为0.941。我们发现与乳腺实质强化（BPE）水平高的患者相比，CEM在BPE水平低的患者中表现更好（ρ = 0.028861）。我们发现CEM时存在额外病变是模型中唯一的显著预测因素。
本研究再次证实了CEM在一大群患者乳腺癌术前分期中的高诊断准确性。
