Diagnostic value of contrast-enhanced spectral mammography for breast lesions: qualitative and quantitative analyses

Breast cancer screening and diagnosis remain to be improved. This study aimed to explore the diagnostic value of contrast-enhanced spectral mammography (CESM) for breast lesions through qualitative and quantitative analyses, and to evaluate the consistency of enhancement curves between CESM and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).

This retrospective study included patients in whom CESM was performed because of suspected (clinical or ultrasound) breast lesions between January 2023 and February 2024 at the Shanxi Bethune Hospital. CESM images were analyzed to obtain mass shape, margin, enhancement, and enlarged lymph nodes. The lesion grey value (LGV) of the region of interest, contrast-to-noise ratio (CNR), and contrast ratio were calculated. The diagnostic value of the qualitative and quantitative metrics for benign and malignant breast lesions was evaluated using receiver operating characteristic (ROC) curves. DCE-MRI images were post-processed, and the enhancement curves were evaluated. A κ consistency analysis was performed to evaluate the enhancement curves between the CESM and DCE-MRI.

This study included 202 female patients: 51 with benign lesions (46.55±11.84 years) and 151 with malignant lesions (51.32±11.21 years). Qualitative analysis showed differences between benign and malignant breast lesions in shape, margin, enhancement, and enlarged lymph nodes in CESM (all P<0.05). The LGV, CNR, and contrast ratio of malignant lesions were higher than in benign lesions (all P<0.001). Regarding the enhancement curves between CESM and DCE-MRI, the concordance rate was 85.42%. Specifically, the concordance rates for enhancement types I, II, and III were 76.19%, 81.67%, and 92.06%, respectively (κ=0.764). The areas under the curves for the qualitative, quantitative, and combined analyses of benign and malignant breast lesions were 0.857, 0.895, and 0.957, respectively.

There were significant differences in the qualitative and quantitative metrics of CESM between benign and malignant lesions, and the combined CESM qualitative and quantitative analysis achieved a high diagnostic value. Moreover, the enhancement curve of CESM demonstrated concordance with those of DCE-MRI. These suggest that CESM may have a promising application in the early diagnosis of breast cancer.