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Enhancement Type at Contrast-enhanced Mammography and Association with Malignancy
Geunwon Kim1, Tejas S Mehta1, Alexander Brook1
1From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (G.K., T.S.M., A.B., L.H.D., K.L., J.P.); and Atrius Health, Newton, Mass (G.K., L.H.D.).
Radiology
|July 12, 2022
Summary
Contrast-enhanced mammography (CEM) findings on recombined images are crucial for malignancy assessment. Mass enhancement, especially with low-energy findings, is highly associated with cancer, while other enhancement types may be benign but still warrant suspicion.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Contrast-enhanced mammography (CEM) use is increasing, but data on recombined image findings and malignancy association are limited.
- Evaluating CEM findings using established lexicons like Breast Imaging Reporting and Data System (BI-RADS) is essential for accurate diagnosis.
Purpose of the Study:
- To determine malignancy rates of enhancement findings on CEM recombined images.
- To assess the impact of co-occurring low-energy findings on malignancy rates.
- To apply the BI-RADS lexicon for mammography and MRI to CEM findings.
Main Methods:
- Retrospective analysis of 371 diagnostic CEM examinations (December 2015 - December 2019).
- Independent review of low-energy and recombined CEM images by three experienced breast radiologists using BI-RADS lexicon.
- Malignancy determination through pathology or 1-year follow-up.
Main Results:
- CEM enhancement sensitivity was 95%, specificity 67%, PPV 55%, and NPV 97%.
- Enhancing lesions were more likely malignant when associated with low-energy findings (59% vs. 26%, P < .001).
- Mass enhancement with low-energy findings had a 63% PPV; other enhancement types without low-energy findings had lower PPVs (6%-38%).
Conclusions:
- Mass enhancement on CEM recombined images is strongly associated with malignancy, particularly when low-energy findings are present.
- Enhancement types without low-energy findings are more likely benign but still require suspicion due to potential malignancy.
- The BI-RADS lexicon is applicable for evaluating CEM findings, aiding in malignancy risk stratification.
