Di Grezia Graziella, Mercogliano Sara, Marinelli Luca, Nazzaro Antonio, Galiano Alessandro, Cisternino Elisa, Gatta Gianluca, Cuccurullo Vincenzo, Scaglione Mariano
Department of Life Sciences, Health and Healthcare Professions Link Campus University, 00165 Rome, Italy.
Breast Unit, Radiology and Diagnostic Imaging Department, AORN Santi Anna e Sebastiano, 81100 Caserta, Italy.
Tomography. 2025 Aug 20;11(8):93. doi: 10.3390/tomography11080093.
Accurate preoperative tumor sizing is critical for optimal surgical planning in breast cancer. Contrast-enhanced mammography (CEM) has emerged as a promising modality, yet its accuracy relative to conventional imaging and pathology requires further validation.
To prospectively evaluate the dimensional accuracy and reproducibility of CEM compared to mammography and ultrasound, using surgical pathology as the reference standard.
A total of 205 patients with 267 breast lesions underwent preoperative CEM, mammography, and ultrasound. Tumor sizes were measured independently by two radiologists. Accuracy was assessed via mean absolute error (MAE), Pearson and Spearman correlations, and inter-reader agreement evaluated by intraclass correlation coefficient (ICC) and Gwet's AC1. Sensitivity analyses included bootstrap confidence intervals and log-transformed data. The surgical impact of additional lesions detected by CEM was also analyzed.
CEM showed superior accuracy with a mean absolute error of 0.46 mm (95% CI: 0.24-0.68) compared to mammography (4.06 mm) and ultrasound (3.52 mm) ( < 0.00001). Pearson's correlation between CEM and pathology was exceptionally high (r = 0.995; 95% CI: 0.994-0.996), with similar robustness after log transformation. Inter-reader agreement for CEM was excellent (ICC 0.93; Gwet's AC1 ~0.96, 95% CI: 0.93-0.98). CEM detected additional lesions in 13.1% of patients, leading to altered surgical management in 6.4%. Background parenchymal enhancement was independently associated with measurement error.
CEM provides highly accurate and reproducible tumor size estimation superior to conventional imaging modalities, with potential clinical impact through detection of additional lesions. Its ability to detect additional lesions not seen on mammography or ultrasound has direct implications for surgical decision making, with the potential to reduce reoperations and improve oncologic and cosmetic outcomes. However, high correlation values and selective patient cohorts warrant cautious interpretation. Further multicenter studies are needed to confirm these findings and define CEM's role in clinical practice.
准确的术前肿瘤大小测量对于乳腺癌的最佳手术规划至关重要。对比增强乳腺X线摄影（CEM）已成为一种有前景的检查方式，但其相对于传统成像和病理学的准确性仍需进一步验证。
以前瞻性地评估CEM与乳腺X线摄影和超声相比在肿瘤尺寸测量方面的准确性和可重复性，以手术病理结果作为参考标准。
共205例患有267个乳腺病变的患者接受了术前CEM、乳腺X线摄影和超声检查。两名放射科医生独立测量肿瘤大小。通过平均绝对误差（MAE）、Pearson和Spearman相关性评估准确性，并通过组内相关系数（ICC）和Gwet's AC1评估阅片者间的一致性。敏感性分析包括自助法置信区间和对数转换数据。还分析了CEM检测到的额外病变对手术的影响。
与乳腺X线摄影（平均绝对误差4.06mm）和超声（平均绝对误差3.52mm）相比，CEM显示出更高的准确性，平均绝对误差为0.46mm（95%置信区间：0.24 - 0.68）（P < 0.00001）。CEM与病理结果之间的Pearson相关性极高（r = 0.995；95%置信区间：0.994 - 0.996），对数转换后仍具有相似的稳健性。CEM的阅片者间一致性极佳（ICC 0.93；Gwet's AC1约为0.96，95%置信区间：0.93 - 0.98）。CEM在13.1%的患者中检测到额外病变，导致6.4%的患者手术管理发生改变。背景实质强化与测量误差独立相关。
CEM提供了高度准确且可重复的肿瘤大小估计，优于传统成像方式，通过检测额外病变具有潜在的临床影响。其检测乳腺X线摄影或超声未发现的额外病变的能力对手术决策有直接影响，有可能减少再次手术并改善肿瘤学和美容效果。然而，高相关值和特定的患者队列需要谨慎解读。需要进一步的多中心研究来证实这些发现并确定CEM在临床实践中的作用。
