Breast Suspicious Microcalcifications on Contrast-Enhanced Mammograms: Practice and Reflection

Area of Science:

• Radiology
• Breast Imaging
• Oncology

Background:

• Suspicious microcalcifications are a common finding in mammography.
• Contrast-enhanced mammography (CEM) is an emerging technique that combines mammography with contrast enhancement to improve lesion detection.

Purpose of the Study:

• To evaluate the diagnostic utility of CEM in cases of suspicious microcalcifications.
• To identify and discuss strategies for managing the limitations of CEM in diagnosing breast lesions.

Main Methods:

• Retrospective analysis of 44 patients with 46 suspicious microcalcification lesions evaluated with CEM.
• Morphological and enhancement pattern analysis of CEM findings, with correlation to pathological results and dynamic contrast-enhanced MRI (DCE-MRI) in a subset of cases.
• Classification of CEM enhancement patterns into enhancement, no enhancement, and indeterminate categories.

Main Results:

• CEM showed enhancement in 43.5% of lesions, no enhancement in 50.0%, and indeterminate findings in 6.5%.
• Mass enhancement was observed in 45% and non-mass enhancement (NME) in 55% of enhancing lesions.
• CEM limitations were noted, including masking effects and false negatives/positives compared to DCE-MRI in specific cases.

Conclusions:

• CEM provides supplementary information regarding enhancement in suspicious microcalcifications.
• CEM is not a definitive diagnostic tool for all suspicious microcalcifications.
• Clinical strategies are required to address the inherent diagnostic limitations of CEM.