Contrast-Enhanced Spectral Mammography in the Evaluation of Breast Microcalcifications: Controversies and Diagnostic Management
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Published:2023-02-09
Issue:4
Volume:11
Page:511
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ISSN:2227-9032
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Container-title:Healthcare
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language:en
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Short-container-title:Healthcare
Author:
Nicosia Luca1ORCID, Bozzini Anna Carla1, Signorelli Giulia1, Palma Simone2ORCID, Pesapane Filippo1ORCID, Frassoni Samuele3ORCID, Bagnardi Vincenzo3, Pizzamiglio Maria1, Farina Mariagiorgia1, Trentin Chiara1, Penco Silvia1, Meneghetti Lorenza1, Sangalli Claudia4ORCID, Cassano Enrico1
Affiliation:
1. Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy 2. Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy 3. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy 4. Data Management, European Institute of Oncology IRCCS, 20141 Milan, Italy
Abstract
The aim of this study was to evaluate the diagnostic performance of contrast-enhanced spectral mammography (CESM) in predicting breast lesion malignancy due to microcalcifications compared to lesions that present with other radiological findings. Three hundred and twenty-one patients with 377 breast lesions that underwent CESM and histological assessment were included. All the lesions were scored using a 4-point qualitative scale according to the degree of contrast enhancement at the CESM examination. The histological results were considered the gold standard. In the first analysis, enhancement degree scores of 2 and 3 were considered predictive of malignity. The sensitivity (SE) and positive predictive value (PPV) were significative lower for patients with lesions with microcalcifications without other radiological findings (SE = 53.3% vs. 82.2%, p-value < 0.001 and PPV = 84.2% vs. 95.2%, p-value = 0.049, respectively). On the contrary, the specificity (SP) and negative predictive value (NPV) were significative higher among lesions with microcalcifications without other radiological findings (SP = 95.8% vs. 84.2%, p-value = 0.026 and NPV = 82.9% vs. 55.2%, p-value < 0.001, respectively). In a second analysis, degree scores of 1, 2, and 3 were considered predictive of malignity. The SE (80.0% vs. 96.8%, p-value < 0.001) and PPV (70.6% vs. 88.3%, p-value: 0.005) were significantly lower among lesions with microcalcifications without other radiological findings, while the SP (85.9% vs. 50.9%, p-value < 0.001) was higher. The enhancement of microcalcifications has low sensitivity in predicting malignancy. However, in certain controversial cases, the absence of CESM enhancement due to its high negative predictive value can help to reduce the number of biopsies for benign lesions
Subject
Health Information Management,Health Informatics,Health Policy,Leadership and Management
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