Latitudinal gradient in the respiration quotient and the implications for ocean oxygen availability.

Climate-driven depletion of ocean oxygen strongly impacts the global cycles of carbon and nutrients as well as the survival of many animal species. One of the main uncertainties in predicting changes to marine oxygen levels is the regulation of the biological respiration demand associated with the biological pump. Derived from the Redfield ratio, the molar ratio of oxygen to organic carbon consumed during respiration (i.e., the respiration quotient, [Formula: see text]) is consistently assumed constant but rarely, if ever, measured. Using a prognostic Earth system model, we show that a 0.1 increase in the respiration quotient from 1.0 leads to a 2.3% decline in global oxygen, a large expansion of low-oxygen zones, additional water column denitrification of 38 Tg N/y, and the loss of fixed nitrogen and carbon production in the ocean. We then present direct chemical measurements of [Formula: see text] using a Pacific Ocean meridional transect crossing all major surface biome types. The observed [Formula: see text] has a positive correlation with temperature, and regional mean values differ significantly from Redfield proportions. Finally, an independent global inverse model analysis constrained with nutrients, oxygen, and carbon concentrations supports a positive temperature dependence of [Formula: see text] in exported organic matter. We provide evidence against the common assumption of a static biological link between the respiration of organic carbon and the consumption of oxygen. Furthermore, the model simulations suggest that a changing respiration quotient will impact multiple biogeochemical cycles and that future warming can lead to more intense deoxygenation than previously anticipated.

Improved Parameterization for the Size Distribution of Emitted Dust Aerosols Reduces Model Underestimation of Super Coarse Dust.

Aircraft measurement campaigns have revealed that super coarse dust (diameter >10 µm) surprisingly accounts for approximately a quarter of aerosols by mass in the atmosphere. However, most global aerosol models either underestimate or do not include super coarse dust abundance. To address this problem, we use brittle fragmentation theory to develop a parameterization for the emitted dust size distribution that includes emission of super coarse dust. We implement this parameterization in the Community Earth System Model (CESM) and find that it brings the model in good agreement with aircraft measurements of super coarse dust close to dust source regions. However, the CESM still underestimates super coarse dust in dust outflow regions. Thus, we conclude that the model underestimation of super coarse atmospheric dust is in part due to the underestimation of super coarse dust emission and likely in part due to errors in deposition processes.

Contrast-Enhanced Spectral Mammography and tumor size assessment: a valuable tool for appropriate surgical management of breast lesions.

PURPOSE: To compare the accuracy of Contrast-Enhanced Spectral Mammography (CESM), MG, US, and breast MRI in estimating the size of breast lesions requiring surgery. The postoperative histology size of the lesion was used as the gold standard. MATERIAL AND METHODS: Two hundred thirty-three non-benign lesions in 189 patients were included in the analyses. All the selected patients underwent CESM and at least one other conventional diagnostic exam (US, MG, or MRI). Subsequently, all the patients underwent surgery preceded by cytological/histological examination. The largest diameter of the lesion at imaging was measured by a radiologist with more than 10 years' experience and then compared with the size of the lesion in the histological sample at the surgery (gold standard). RESULTS: Among the 233 breast lesions, 196 were evaluated with US, 206 with MG and 160 with MRI. We found no statistically significant differences between size measurements using CESM and MRI compared with the measurements at the surgery (p value 0.63 and 0.51), whereas a significant difference was found for MG and US (p < 0.001). CONCLUSION: CESM is a reliable method for estimating the size of breast lesions: its performance seems superior to US and MG and comparable to MRI.

Radiomic Features Applied to Contrast Enhancement Spectral Mammography: Possibility to Predict Breast Cancer Molecular Subtypes in a Non-Invasive Manner.

We aimed to investigate the association between the radiomic features of contrast-enhanced spectral mammography (CESM) images and a specific receptor pattern of breast neoplasms. In this single-center retrospective study, we selected patients with neoplastic breast lesions who underwent CESM before a biopsy and surgical assessment between January 2013 and February 2022. Radiomic analysis was performed on regions of interest selected from recombined CESM images. The association between the features and each evaluated endpoint (ER, PR, Ki-67, HER2+, triple negative, G2-G3 expressions) was investigated through univariate logistic regression. Among the significant and highly correlated radiomic features, we selected only the one most associated with the endpoint. From a group of 321 patients, we enrolled 205 malignant breast lesions. The median age at the exam was 50 years (interquartile range (IQR) 45-58). NGLDM_Contrast was the only feature that was positively associated with both ER and PR expression (p-values = 0.01). NGLDM_Coarseness was negatively associated with Ki-67 expression (p-value = 0.02). Five features SHAPE Volume(mL), SHAPE_Volume(vx), GLRLM_RLNU, NGLDM_Busyness and GLZLM_GLNU were all positively and significantly associated with HER2+; however, all of them were highly correlated. Radiomic features of CESM images could be helpful to predict particular molecular subtypes before a biopsy.

Current Status of Contrast Enhanced Mammography: A Comprehensive Review.

OBJECTIVES: The purpose of this article is to provide a detailed and updated review of the physics, techniques, indications, limitations, reporting, implementation and management of contrast enhanced mammography. BACKGROUND: Contrast enhanced mammography (CEM), is an emerging iodine-based modified dual energy mammography technique. In addition to having the same advantages as standard full-field digital mammography (FFDM), CEM provides information regarding tumor enhancement, relying on tumor angiogenesis, similar to dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). This article reviews current literature on CEM and highlights considerations that are critical to the successful use of this modality. CONCLUSION: Multiple studies point to the advantage of using CEM in the diagnostic setting of breast imaging, which approaches that of DCE-MRI.

Interannual and Seasonal Drivers of Carbon Cycle Variability Represented by the Community Earth System Model (CESM2).

Earth system models are intended to make long-term projections, but they can be evaluated at interannual and seasonal time scales. Although the Community Earth System Model (CESM2) showed improvements in a number of terrestrial carbon cycle benchmarks, relative to its predecessor, our analysis suggests that the interannual variability (IAV) in net terrestrial carbon fluxes did not show similar improvements. The model simulated low IAV of net ecosystem production (NEP), resulting in a weaker than observed sensitivity of the carbon cycle to climate variability. Low IAV in net fluxes likely resulted from low variability in gross primary productivity (GPP)-especially in the tropics-and a high covariation between GPP and ecosystem respiration. Although lower than observed, the IAV of NEP had significant climate sensitivities, with positive NEP anomalies associated with warmer and drier conditions in high latitudes, and with wetter and cooler conditions in mid and low latitudes. We identified two dominant modes of seasonal variability in carbon cycle flux anomalies in our fully coupled CESM2 simulations that are characterized by seasonal amplification and redistribution of ecosystem fluxes. Seasonal amplification of net and gross carbon fluxes showed climate sensitivities mirroring those of annual fluxes. Seasonal redistribution of carbon fluxes is initiated by springtime temperature anomalies, but subsequently negative feedbacks in soil moisture during the summer and fall result in net annual carbon losses from land. These modes of variability are also seen in satellite proxies of GPP, suggesting that CESM2 appropriately represents regional sensitivities of photosynthesis to climate variability on seasonal time scales.

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.

Added value of contrast-enhanced mammography (CEM) in staging of malignant breast lesions-a feasibility study.

OBJECTIVES: The aim of this feasibility study was to evaluate the added value of contrast-enhanced mammography (CEM) in preoperative staging of malignant breast lesions, beyond standard assessment with digital mammography and ultrasound, as a base for a future prospective randomized trial. MATERIALS AND METHODS: Forty-seven patients, with confirmed or strongly suspected malignant breast lesions after standard assessment (digital mammography (DM) and ultrasound (US)), scheduled for primary surgery, were invited to undergo CEM as an additional preoperative procedure. The primary endpoint was change in treatment due to CEM findings, defined as mastectomy instead of partial mastectomy or contrariwise, bilateral surgery instead of unilateral or neoadjuvant treatment instead of primary surgery. Accuracy in tumour extent estimation compared to histopathology was evaluated by Bland-Altman statistics. Number of extra biopsies and adverse events were recorded. RESULTS: In 10/47 patients (21%), findings from CEM affected the primary treatment. Agreement with histopathology regarding extent estimation was better for CEM (mean difference - 1.36, SD ± 18.45) in comparison with DM (- 4.18, SD ± 26.20) and US (- 8.36, SD ± 24.30). Additional biopsies were taken from 19 lesions in 13 patients. Nine biopsies showed malignant outcome. No major adverse events occurred. CONCLUSION: The feasibility of preoperative additional CEM was found to be satisfactory without any serious negative effects. Results imply an added value of CEM in preoperative staging of breast cancer. Further evaluation in larger prospective randomized trials is needed. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03402529. Registered 18 January 2018-retrospectively registered.

The new method, the old problem - role of contrast-enhanced spectral mammography in the diagnosis of breast cancer among Polish women.

PURPOSE: The aim of the study was to evaluate spectral mammography (CESM) in diagnosing breast cancer, which is based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). MATERIAL AND METHODS: The study included a group of 547 women who underwent spectral mammography and histopathological verification of the lesion, previously seen in mammography and/or ultrasound. In the group of 547 women, 593 focal lesions were diagnosed. All CESM examinations were carried-out with a digital mammography device dedicated to performing dual-energy CESM acquisitions. An intravenous injection of 1.5 ml/kg of body mass of non-ionic contrast agent was performed. RESULTS: The analysis includes 593 breast lesions, in this group cancer was detected in 327 (55.14%) lesions, and in 256 (43.17%) cases benign lesions were confirmed by histopathological examination and at least 12 months of observation. The method shows differentiation of benign and malignant lesions in the breast: sensitivity of 97.86%, specificity of 59.4%, PPV - 74.76%, NPV - 95.76%. CONCLUSIONS: Spectral mammography could be an ideal method to detect breast cancer. Thanks to the high NPV (95.76%), it facilitates the exclusion of cancer in situations where pathological contrast enhancement is not observed. The unsatisfactory specificity of the study (59.4%) would not make it safe to avoid a core needle biopsy of lesions that undergo contrast enhancement.

Diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM): a retrospective study involving 644 breast lesions.

OBJECTIVE: To evaluate the diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM) in comparison with that of full-field digital mammography (FFDM), either alone or accompanied with breast ultrasound (BUS) in a large series of patients/breast lesions (n = 644). PATIENTS AND METHODS: In this retrospective study, five radiologists evaluated the lesions by three imaging modalities: FFDM, FFDM + BUS, and CESM and compared the imaging to the gold standard (histopathology or clinical follow-up). Diagnostic performance parameters and receiver operating characteristic (ROC) curves of CESM were calculated and compared to those of FFDM or FFDM + BUS (McNemar's test). Additionally, the reliability of tumor size measurement by CESM was compared with the histopathological measurement. RESULTS: The study included 218 benign and 426 malignant lesions. 85% of benign and 93% of malignant lesions were adequately identified using CESM. With respect to FFDM and FFDM + BUS, CESM significantly increased sensitivity to 93.2% (+ 10.7% and + 3.4%, respectively); specificity to 84.4% (+ 15.8% and + 1.7%, respectively); PPV to 92.3% (+ 26.8% and + 3.6%, respectively); NPV to 86.0% (+ 1.6% and + 1.8%, respectively); and accuracy to 90.2% (+ 15.8% and + 3.2%, respectively). In the ROC curves analyses, the comparison among the three AUC values was also statistically significant (p < 0.001). Good agreement between tumor diameters measured using CESM and histopathology was observed (Spearman's rank correlation, r = 0.891, p < 0.0001), although this technique tended to produce an overestimation of the size (+ 7 mm). CONCLUSIONS: CESM has high diagnostic accuracy and can be considered as a useful technique for the assessment of breast lesions.

Modelled biophysical impacts of conservation agriculture on local climates.

Including the parameterization of land management practices into Earth System Models has been shown to influence the simulation of regional climates, particularly for temperature extremes. However, recent model development has focused on implementing irrigation where other land management practices such as conservation agriculture (CA) has been limited due to the lack of global spatially explicit datasets describing where this form of management is practiced. Here, we implement a representation of CA into the Community Earth System Model and show that the quality of simulated surface energy fluxes improves when including more information on how agricultural land is managed. We also compare the climate response at the subgrid scale where CA is applied. We find that CA generally contributes to local cooling (~1°C) of hot temperature extremes in mid-latitude regions where it is practiced, while over tropical locations CA contributes to local warming (~1°C) due to changes in evapotranspiration dominating the effects of enhanced surface albedo. In particular, changes in the partitioning of evapotranspiration between soil evaporation and transpiration are critical for the sign of the temperature change: a cooling occurs only when the soil moisture retention and associated enhanced transpiration is sufficient to offset the warming from reduced soil evaporation. Finally, we examine the climate change mitigation potential of CA by comparing a simulation with present-day CA extent to a simulation where CA is expanded to all suitable crop areas. Here, our results indicate that while the local temperature response to CA is considerable cooling (>2°C), the grid-scale changes in climate are counteractive due to negative atmospheric feedbacks. Overall, our results underline that CA has a nonnegligible impact on the local climate and that it should therefore be considered in future climate projections.

Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging.

BACKGROUND: Neoadjuvant-chemotherapy (NAC) is considered the standard treatment for locally advanced breast carcinomas. Accurate assessment of disease response is fundamental to increase the chances of successful breast-conserving surgery and to avoid local recurrence. The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) and contrast-enhanced-MRI (MRI) in the evaluation of tumor response to NAC. METHODS: This prospective study was approved by the institutional review board and written informed consent was obtained. Fifty-four consenting women with breast cancer and indication of NAC were consecutively enrolled between October 2012 and December 2014. Patients underwent both CESM and MRI before, during and after NAC. MRI was performed first, followed by CESM within 3 days. Response to therapy was evaluated for each patient, comparing the size of the residual lesion measured on CESM and MRI performed after NAC to the pathological response on surgical specimens (gold standard), independently of and blinded to the results of the other test. The agreement between measurements was evaluated using Lin's coefficient. The agreement between measurements using CESM and MRI was tested at each step of the study, before, during and after NAC. And last of all, the variation in the largest dimension of the tumor on CESM and MRI was assessed according to the parameters set in RECIST 1.1 criteria, focusing on pathological complete response (pCR). RESULTS: A total of 46 patients (85%) completed the study. CESM predicted pCR better than MRI (Lin's coefficient 0.81 and 0.59, respectively). Both methods tend to underestimate the real extent of residual tumor (mean 4.1mm in CESM, 7.5mm in MRI). The agreement between measurements using CESM and MRI was 0.96, 0.94 and 0.76 before, during and after NAC respectively. The distinction between responders and non-responders with CESM and MRI was identical for 45/46 patients. In the assessment of CR, sensitivity and specificity were 100% and 84%, respectively, for CESM, and 87% and 60% for MRI. CONCLUSION: CESM and MRI lesion size measurements were highly correlated. CESM seems at least as reliable as MRI in assessing the response to NAC, and may be an alternative if MRI is contraindicated or its availability is limited.

Potential Cost Savings of Contrast-Enhanced Digital Mammography.

OBJECTIVE: The purpose of this article is to discuss whether the sensitivity and specificity of contrast-enhanced digital mammography (CEDM) render it a viable diagnostic alternative to breast MRI. CONCLUSION: That CEDM couples low-energy images (comparable to the diagnostic quality of standard mammography) and subtracted contrast-enhanced mammograms make it a cost-effective modality and a realistic substitute for the more costly breast MRI.

Contrast-enhanced spectral mammography in recalls from the Dutch breast cancer screening program: validation of results in a large multireader, multicase study.

OBJECTIVES: Contrast-enhanced spectral mammography (CESM) is a promising problem-solving tool in women referred from a breast cancer screening program. We aimed to study the validity of preliminary results of CESM using a larger panel of radiologists with different levels of CESM experience. METHODS: All women referred from the Dutch breast cancer screening program were eligible for CESM. 199 consecutive cases were viewed by ten radiologists. Four had extensive CESM experience, three had no CESM experience but were experienced breast radiologists, and three were residents. All readers provided a BI-RADS score for the low-energy CESM images first, after which the score could be adjusted when viewing the entire CESM exam. BI-RADS 1-3 were considered benign and BI-RADS 4-5 malignant. With this cutoff, we calculated sensitivity, specificity and area under the ROC curve. RESULTS: CESM increased diagnostic accuracy in all readers. The performance for all readers using CESM was: sensitivity 96.9 % (+3.9 %), specificity 69.7 % (+33.8 %) and area under the ROC curve 0.833 (+0.188). CONCLUSION: CESM is superior to conventional mammography, with excellent problem-solving capabilities in women referred from the breast cancer screening program. Previous results were confirmed even in a larger panel of readers with varying CESM experience. KEY POINTS: • CESM is consistently superior to conventional mammography • CESM increases diagnostic accuracy regardless of a reader's experience • CESM is an excellent problem-solving tool in recalls from screening programs.

The tumour border on contrast-enhanced spectral mammography and its relation to histological characteristics of invasive breast cancer.

Contrast-enhanced spectral mammography (CESM) is one of the new diagnostic modalities implemented in clinical practice. In the case of these techniques, there are two major issues to be addressed: (1) their diagnostic usefulness, and (2) the relation between parameters assessed using these techniques and well-known diagnostic/prognostic/predictive markers (histological, clinical, and molecular). Therefore, we studied the relationship between the tumour margin assessed on CESM and (1) tumour borders defined on the basis of macroscopic and microscopic examination, (2) pT, (3) pN, and (4) tumour grade in a group of 82 breast cancer patients. Based on CESM, the tumour border was defined as sharp, indistinct or spiculated, whereas in the case of lesions showing weak or medium enhancement on CESM the borders were classified as unspecified. We found a statistically significant relationship between tumour margin on CESM and (1) macroscopic border (a spiculated margin on CESM was found only in carcinomas with an invasive border on histological examination; p = 0.004), (2) pT (p = 0.016), and (3) pN (nodal involvement was observed most frequently in carcinomas with a spiculated or indistinct margin on CESM; p = 0.045). Moreover, in cases with an undefined margin on CESM (cases showing weak or medium enhancement on CESM), both invasive and pushing borders were found on histological examination. The results of our preliminary study suggest that it is possible to assess macroscopic borders of examined lesions on the basis of CESM imaging. This might be useful in planning the extent of surgical excision. On the other hand, the assessment of the tumour margin on CESM might not be precise in cases showing weak enhancement.

A deep learning approach for virtual contrast enhancement in Contrast Enhanced Spectral Mammography.

Contrast Enhanced Spectral Mammography (CESM) is a dual-energy mammographic imaging technique that first requires intravenously administering an iodinated contrast medium. Then, it collects both a low-energy image, comparable to standard mammography, and a high-energy image. The two scans are combined to get a recombined image showing contrast enhancement. Despite CESM diagnostic advantages for breast cancer diagnosis, the use of contrast medium can cause side effects, and CESM also beams patients with a higher radiation dose compared to standard mammography. To address these limitations, this work proposes using deep generative models for virtual contrast enhancement on CESM, aiming to make CESM contrast-free and reduce the radiation dose. Our deep networks, consisting of an autoencoder and two Generative Adversarial Networks, the Pix2Pix, and the CycleGAN, generate synthetic recombined images solely from low-energy images. We perform an extensive quantitative and qualitative analysis of the model's performance, also exploiting radiologists' assessments, on a novel CESM dataset that includes 1138 images. As a further contribution to this work, we make the dataset publicly available. The results show that CycleGAN is the most promising deep network to generate synthetic recombined images, highlighting the potential of artificial intelligence techniques for virtual contrast enhancement in this field.

Diagnostic Accuracy and Incremental Value of Contrast-Enhanced Mammography Compared With Full Field Digital Mammography in a Tertiary Cancer Care Center.

OBJECTIVE: To assess the diagnostic accuracy and incremental value of contrast-enhanced mammography (CEM) compared with full-field digital mammography (FFDM). METHODOLOGY: A retrospective analysis was performed with 150 consecutive patients who underwent CEM at our institute between November 2020 and February 2021, fulfilling the inclusion criteria. The first round of analysis included a review of FFDM with an interpretation of findings as per the Breast Imaging Reporting and Data System (BIRADS) lexicon and the assignment of the BIRADS category to the detected abnormalities. After this documentation, a second round of analysis included a review of recombined subtracted images of CEM. The diagnostic accuracy of FFDM and CEM was calculated with histopathology as the gold standard. RESULTS: Among the 150 cases assessed, 202 lesions were detected with histopathological correlation, of which 42 were benign and 160 were malignant. The sensitivity of FFDM was 90.6% compared to 98.12% for CEM. The specificity of FFDM was 66.7% compared to 76.19% for CEM. The negative predictive value (NPV) of FFDM was low, at 65.12%; CEM showed a better NPV, at 91.43%. The positive predictive value (PPV) was almost the same, at 94.01% for CEM and 91.19% for FFDM. The area under the curve (AUC) was superior for CEM compared to that of FFDM, with a value of 0.87. FFDM had a low sensitivity, especially in dense breast parenchyma, at 88.79% and a specificity of 70%, whereas CEM showed a higher sensitivity, specificity, and NPV, measuring 99.14%, 76.67%, and 95.83%, respectively. CONCLUSION: Superior sensitivity and high NPV for CEM make it a preferable modality compared with FFDM, especially in dense breast parenchyma, where CEM overcomes the limitations of FFDM. We conclude that CEM is superior to FFDM in evaluating the extent of disease, additional satellite lesion detection, and ruling out ambiguous findings.

State-of-the-art for contrast-enhanced mammography.

Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.

Brief communication: The current status of contrast-enhanced mammography in breast imaging.

Improvising and developing state of the art techniques for breast cancer detection have always been an area of great interest in the field of imaging. Adding intravenous contrast to any imaging study, is well-known to increase the sensitivity and specificity of detection of a pathological process, especially in the setting of neoplasia secondary to tumor neoangiogenesis. Contrast enhanced MRI is known to be highly sensitive breast cancer screening tool till date, however, has been limited by long scan times, claustrophobia experienced by some women and high false positive findings. Despite continued advances in digital mammography technique, significant limitations have always been experienced in detection of small cancers especially in the setting of dense breast parenchyma. Implementing dual energy subtraction technique to digital mammography, made contrast enhanced mammography a viable technique to improve cancer detection. We aim to discuss the status of contrast enhanced mammography in this brief communication, emphasizing technical background, image acquisition, clinical applications, and future directions.

Contrast-Enhanced Spectral Mammography in the Evaluation of Breast Microcalcifications: Controversies and Diagnostic Management.

The aim of this study was to evaluate the diagnostic performance of contrast-enhanced spectral mammography (CESM) in predicting breast lesion malignancy due to microcalcifications compared to lesions that present with other radiological findings. Three hundred and twenty-one patients with 377 breast lesions that underwent CESM and histological assessment were included. All the lesions were scored using a 4-point qualitative scale according to the degree of contrast enhancement at the CESM examination. The histological results were considered the gold standard. In the first analysis, enhancement degree scores of 2 and 3 were considered predictive of malignity. The sensitivity (SE) and positive predictive value (PPV) were significative lower for patients with lesions with microcalcifications without other radiological findings (SE = 53.3% vs. 82.2%, p-value < 0.001 and PPV = 84.2% vs. 95.2%, p-value = 0.049, respectively). On the contrary, the specificity (SP) and negative predictive value (NPV) were significative higher among lesions with microcalcifications without other radiological findings (SP = 95.8% vs. 84.2%, p-value = 0.026 and NPV = 82.9% vs. 55.2%, p-value < 0.001, respectively). In a second analysis, degree scores of 1, 2, and 3 were considered predictive of malignity. The SE (80.0% vs. 96.8%, p-value < 0.001) and PPV (70.6% vs. 88.3%, p-value: 0.005) were significantly lower among lesions with microcalcifications without other radiological findings, while the SP (85.9% vs. 50.9%, p-value < 0.001) was higher. The enhancement of microcalcifications has low sensitivity in predicting malignancy. However, in certain controversial cases, the absence of CESM enhancement due to its high negative predictive value can help to reduce the number of biopsies for benign lesions.