Can the delayed phase of quantitative contrast-enhanced mammography improve the diagnostic performance on breast...

Contrast-enhanced mammography (CEM) is an imaging tool for breast cancer detection. Most quantitative analyses of CEM involve two phases, and it is unknown whether an added delayed phase can improve its diagnostic performance compared to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). This study aimed to evaluate whether the delayed phase improves the diagnostic performance of CEM in distinguishing malignant and benign masses.

This prospective study enrolled 111 women with 111 pathologically confirmed breast masses. CEM was performed after the injection of contrast agent between 2-3 minutes (T1, early phase), 4-5 minutes (T2, second phase), and 7-9 minutes (T3, delayed phase). The quantitative enhanced gray value of lesions (LGV) and the lesion to background grey value ratio (LBR) were measured within each phase's corresponding region of interest (ROI). Based on their changes, the kinetic enhancement pattern was assessed among the three phases, and the diagnostic performance was subsequently measured.

The LGV and LBR of malignant masses were significantly greater than those of benign lesions. The diagnostic performance of LGV and LBR at the delayed phase was consistent with that of the second phase but poorer than that of the early phase. The sensitivity of LGV_T1 + LGV_T2 + LGV_T3 was less than that of LGV_T1 + LGV_T2 (86.5% vs. 95.1%) with a similar area under the curve (AUC), specificity, positive-predictive value (PPV), negative-predictive value (NPV), and accuracy. The sensitivity of LBR_T1 + LBR_T2 + LBR_T3 increased by 19.6%, and specificity decreased by 20.7% compared with LBR_T1 + LBR_T2. The LGV_T1 + LGV_T2 + LGV_T3 + kinetic enhancement (T1-T3) had the lowest sensitivity (67.0%), but the highest specificity (75.8%), and the sensitivity of LBR_T1 + LBR_T2 + LBR_T3 + kinetic enhancement (T1-T3) was higher than that of LBR_T1 + LBR_T2 + kinetic enhancement (T1-T2) (90.2% vs. 63.4%, respectively).

The addition of a delayed CEM phase for breast cancer diagnosis yielded limited performance improvement. The quantitative analysis combined with enhancement patterns between the two consecutive phases has great potential to distinguish between malignant and benign lesions.