The cone-beam breast computed tomography characteristics of breast non-mass enhancement lesions

Abstract

Background Cone-beam computed tomography (CBBCT) of the breast is emerging as a way of improving breast cancer diagnostic yield. Purpose To find characteristics of non-mass enhancement (NME) lesions on breast CBBCT and to identify the characteristics that distinguish malignant and benign lesions. Material and Methods Breast CBBCT images of 84 NME lesions were analyzed. Internal enhancement distribution and patterns, calcification distribution and suspicious morphology, and ΔHU enhancement values were compared between post-contrast and pre-contrast malignant and benign lesions. Univariate analyses were applied to find the strongest indicators of malignancy, and logistic regression analysis was used to develop a fitting equation for the combined diagnostic model. Results In the 84 NME lesions, the indicators of malignancy were as follows: segmental enhancement distribution ( P = 0.011, 53.62% sensitivity, 86.67% specificity, 94.87% positive predictive value [PPV], and 28.89% negative predictive value [NPV]), clumped internal enhancement patterns ( P = 0.017, 50.72% sensitivity, 86.67% specificity, 94.59% PPV, and 27.66% NPV), ΔHU ≥ 93.57 Hounsfield units (HU) ( P = 0.004, 66.67% sensitivity, 73.33% specificity, 92.00% PPV, and 32.35% NPV), and NME lesions with calcification ( P = 0.002, 36.23% sensitivity, 20.00% specificity, 82.14% PPV, and 67.57% NPV). The fitting equation for the combined diagnostic model was as follows: Logit (P) = –0.579 +1.318 × enhancement distribution + 1.000 × internal enhancement patterns + 1.539 × ΔHU value + 1.641 ×NME type. Conclusion Individual diagnostic criteria based on breast CBBCT characteristics (segmental enhancement distribution, clumped internal enhancement patterns, ΔHU values > 93.57 HU, and NME lesions with calcification) had high specificity and PPV; when combined, they had high sensitivity in predicting malignant NME lesions.