Contrast-Enhanced Mammography (CEM) Capability to Distinguish Molecular Breast Cancer Subtypes.

With breast cancer ranking first among the most common malignant neoplasms in the world, new techniques of early detection are in even more demand than before. Our awareness of tumors' biology is expanding and may be used to treat patients more efficiently. A link between radiology and pathology was searched for in our study, as well as the answer to the question of whether a tumor type can be seen on contrast-enhanced mammography and if such knowledge may serve as part of precision medicine.

The effectiveness of contrast-enhanced spectral mammography and magnetic resonance imaging in dense breasts.

PURPOSE: Breast cancer is the most common cause of death from neoplastic disease in women. Among all breast anatomy types, glandular type is the most problematic concerning evaluation. While digital mammography still remains the basic diagnostic tool, one must be aware of its limitations in dense breasts. Although magnetic resonance imaging (MRI) has greatly improved sensitivity, its specificity is low. Moreover, there are contraindications for MRI for some patients, so a substitute has been searched for. This study was performed to check if contrast-enhanced spectral mammography (CESM) can be a viable option for patients with dense breasts. MATERIAL AND METHODS: The study involved 121 patients with abnormalities detected on base-line diagnostic imaging (ultrasound or mammography). The patients had subsequent examinations, both CESM and MRI performed within a maximum 2-month time interval. The sensitivity and specificity of both methods in the whole group as well as in specific breast structure types were measured and compared. RESULTS: Contrast enhancement was visible in all 121 cases on MRI, while on CESM lack of enhancement was noted in 13 cases. All of those 13 lesions turned out to be benign. There were 40 (33%) benign and 81 (69%) malignant tumours. The analysed group included 53 (44%) glandular type breast patients, 39 (32%) mixed type, and 29 (23%) fatty type. Although MRI proved to be slightly more effective in dense breasts, both methods showed similar results in the whole study group. CONCLUSION: CESM can be used with confidence in patients with glandular breast type when MRI is not available or there are reported contraindications to MRI.

Analysis of background parenchymal enhancement (BPE) on contrast enhanced spectral mammography compared with magnetic resonance imaging.

OBJECTIVES: With the growing number of new breast cancer cases in women, new methods of imaging arise. Contrast enhanced spectral mammography (CESM) and magnetic resonance imaging (MRI) are comparable methods regarding sensitivity. The aim of this study is to check if analysis of background parenchymal enhancement on CESM can improve its usefulness. MATERIAL AND METHODS: A total of 64 patients with breast lesions found previously on ultrasound or mammography underwent MRI and CESM within less than one month. On MRI the contrast enhancement kinetics and visual BPE were evaluated. On CESM the enhancement of lesions was noted as well as a quantitative level of BPH. The gathered data was analysed in terms of patterns and relations. RESULTS: A total of 66 lesions were identified both on MRI and CESM, including 11 (17%) benign and 55 (83%) malignant lesions. Among malignant lesions 13 (20%) were assessed as intraductal and 42 (64%) as infiltrating carcinomas. The study showed correlation between the level of enhancement on CESM and the type of kinetic curve on MRI and lesion enhance-ment on CESM as well as confirmed the fact that the BPE is a destimulant in both methods of imaging. CONCLUSIONS: Evaluation of BPE level on CESM can help reading radiologists to define a lesion as malignant with higher probability than based only on the qualitative lesion enhancement level.

Correlation Between Enhancement Intensity in Contrast Enhancement Spectral Mammography and Types of Kinetic Curves in Magnetic Resonance Imaging.

BACKGROUND Due to the decreased sensitivity of mammography in glandular breasts, new diagnostic modalities, like contrast-enhanced spectral mammography (CESM) and digital breast tomosynthesis (DBT) have been developed. The aim of this study was to compare qualitative enhancement levels on CESM with type of kinetic enhancement curves on MRI examination. MATERIAL AND METHODS Patients qualified for the CESM examination presented some diagnostic doubts - suspected multifocality, multicentricity, or having dense glandular breast tissue. The enhancement level on CESM was described as weak, medium, or strong. Enhancement on achieved MR images was assessed on the basis of enhancement kinetic curves. The level of enhancement on CESM was associated with enhancement curves type on MRI. All lesions detected on CESM and MRI were histopathologically verified. RESULTS The study involved 107 lesions diagnosed in 94 patients: 71 lesions (66%) appeared to be infiltrating on histopathological examination, 9 lesions (8%) were non-infiltrating cancers, and 27 lesions (25%) were benign. Data analysis revealed that lesions with wash-out curve on MRI most often presented strong enhancement on CESM, while in lesions with progressive enhancement curve, strong enhancement on CESM was the rarest. The relationship between enhancement level on CESM and curve type on contrast-enhanced MRI depends on the nature of the lesion. The type of MRI curve was found to be associated with enhancement level on CESM. CONCLUSIONS We compared subjective assessments of contrast enhancement on CESM with enhancement kinetic curves on MRI. The results showed that the level of enhancement on CESM and type of kinetic curves on MRI depends on the lesion type.