Impact of Background Parenchymal Enhancement (BPE) on diagnostic performance of Contrast-Enhanced Mammography (CEM) for breast cancer diagnosis.

OBJECTIVES

This study investigates how background parenchymal enhancement (BPE) impacts diagnostic performance in interpretation of contrast-enhanced mammography (CEM) for breast cancer diagnosis.

MATERIALS & METHODS: Retrospective IRB-approved single-center observational study on CEM-patients between 07/2020-09/2022. Indications for CEM were inconclusive or suspicious breast lesions identified by screening or diagnostic mammography and/or ultrasound. CEM was evaluated using the BI-RADS lexicon CEM supplement. BPE was assessed by one supervised reader and dichotomized as minimal/mild and moderate/marked. Exclusion criteria included patients without a 24-month follow-up, histology or CEM images were not available for technical reasons. Image interpretation was conducted by board-certified radiologists. All readers were blinded to patient clinical data and histopathology results. Statistical analysis included Kappa statistics and ROC analysis. Diagnostic metrics were calculated at a BI-RADS > 3 cut-off. P-values < 0.05 indicated statistical significance.

RESULTS

229 female patients (mean age 53.8 ± 10.7 years) were included. BPE was minimal in 49.3 %, mild in 36.8 %, moderate in 12.5 %, and marked in 1.4 % of patients. Overall AUC was higher in minimal/mild BPE (0.94 ± 0.01) compared to moderate/marked BPE (0.82 ± 0.04), which proved statistically significant (difference 0.12, p = 0.004). Sensitivity was higher in the minimal/mild BPE group at 90.9 % compared to 66.7 % in the moderate/marked BPE group (p = 0.05). Specificity was significantly higher in the minimal/mild vs. moderate/marked BPE group, p = 0.0006).

CONCLUSION

BPE significantly affects the diagnostic performance of CEM, particularly sensitivity. This highlights the importance of assessing and reporting BPE in CEM to provide a simple metric indicating the reliability of test results.