The Value of Contrast-Enhanced Digital Mammography Compared to Magnetic Resonance Imaging in the Analysis of Mammographically Detected Suspicious Breast Lesions

Cilj: Princip oslikavanja na kontrastnoj digitalnoj mamografiji (CEDM) temelji se na istom principu kao kod magnetske rezonancije (MR), tj. u prikazu neovaskularizacije. Cilj našega rada je usporedba osjetljivosti CEDM-a u detekciji malignih lezija u dojci s MR-om te određivanje osjetljivosti i specifičnosti navedenih metoda. Ispitanici i metode: Uključeno je 56 ispitanika (55 žena i jedan muškarac; medijan dobi 63,51 godina; raspon 40 – 88 godina) kod kojih je temeljem nalaza na digitalnoj mamografiji postavljena sumnja na maligni proces u dojci. Kod svih ispitanika učinjen je ultrazvuk dojki, MR i CEDM te biopsija suspektne lezije. Indikacija za CEDM je nejasna ili suspektna sjena, distorzija, asimetrija ili nakupina patoloških mikrokalcifikata na digitalnoj mamografiji. Rezultati: Kod 13 (23,21 %) ispitanika došlo je do kontrastne imbibicije lezija na CEDM-u i MR-u. Od ukupnog broja ispitanika, kod njih 15 (26,78 %) dijagnosticirana je maligna lezija, a u 17,85 % došlo je do kontrastne imbibicije samo na CEDM procedure, od kojih je 7 lezija bilo maligno (invazivni karcinom te duktalni karcinom in situ s invazivnom komponentom). Specifičnost i osjetljivost MR-a iznosi 97,1 %, i 85,7 % (ROC-AUC = 0,914, PPV 92,3 %, NPV 94,3 %). Specifičnost i osjetljivost CEDM-a iznosi 94,1 %, odnosno 100 % (ROC-AUC = 0,971, PPV 91,3 %, NPV 100 %). Zaključak: CEDM je procedura jednakovrijedna MR-u u detekciji suspektnih lezija u dojci te može zamijeniti MR u procjeni proširenosti bolesti kada MR nije dostupan ili je kontraindiciran. CEDM je komplementarna dijagnostička metoda MR-u kada se MR ne može napraviti te pokazuje dobru korelaciju u detekciji malignih lezija u dojci.
Objective: The imaging principle of contrast-enhanced digital mammography (CEDM) is based on the same principle as magnetic resonance imaging (MR), i.e., the representation of neovascularization. The aim of this work is to compare the sensitivity of CEDM in the detection of malignant lesions in the breast with MR and to determine the sensitivity and specificity of the mentioned methods. Patients and methods: Fifty-six subjects were included (55 women and 1 man; median age 63.51 years; range 40-88 years) in whom, based on findings on digital mammography, the suspicion of a malignant process on the breast was raised. All subjects underwent breast ultrasound, MR, CEDM, and a biopsy of the suspicious lesion was performed. An indication for CEDM is a vague or suspicious shadow, distortion, asymmetry, or a cluster of pathological microcalcifications on digital mammography. Results: In 13 (23.21%) subjects there was contrast enhancement of lesions on both CEDM and MR. Of the total number of subjects, 15 (26.78%) were diagnosed with a malignant lesion, and in 17,85% contrast enhancement occurred only during the CEDM procedure, of which 7 lesions were malignant (invasive carcinoma and ductal carcinoma in situ with an invasive component). The specificity and sensitivity of MR is 97.1% and 85.7%, respectively (ROC-AUC = 0.914, PPV 92.3%, NPV 94.3%). The specificity and sensitivity of CEDM is 94.1% and 100%, respectively (ROC-AUC = 0.971, PPV 91.3%, NPV 100%). Conclusion: CEDM is a procedure equivalent to MR in the detection of suspicious lesions in the breast and may replace MR in assessing the extent of disease when MR is unavailable or contraindicated. CEDM is a complementary diagnostic method to MR when MR cannot be performed and shows a good correlation in the detection of malignant lesions in the breast.