title: Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions.
abstract: OBJECTIVE
  To analyze the morphology and enhancement characteristics of breast lesions on contrast-enhanced spectral mammography (CESM) and to assess their impact on the differentiation between benign and malignant lesions.
  
  
  METHODS
  This ethics committee approved study included 168 consecutive patients with 211 breast lesions over 18 months. Lesions classified as non-enhancing and enhancing and then the latter group was subdivided into mass and non-mass. Mass lesions descriptors included: shape, margins, pattern and degree of internal enhancement. Non-mass lesions descriptors included: distribution, pattern and degree of internal enhancement. The impact of each descriptor on diagnosis individually assessed using Chi test and the validity compared in both benign and malignant lesions. The overall performance of CESM were also calculated.
  
  
  RESULTS
  The study included 102 benign (48.3%) and 109 malignant (51.7%) lesions. Enhancement was encountered in 145/211 (68.7%) lesions. They further classified into enhancing mass (99/145, 68.3%) and non-mass lesions (46/145, 31.7%). Contrast uptake was significantly more frequent in malignant breast lesions (p value ≤ 0.001). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p value ≤ 0.001). CESM showed an overall sensitivity of 88.99% and specificity of 83.33%. The positive and negative likelihood ratios were 5.34 and 0.13 respectively.
  
  
  CONCLUSIONS
  The assessment of the morphology and enhancement characteristics of breast lesions on CESM enhances the performance of digital mammography in the differentiation between benign and malignant breast lesions.
authors.affiliation: Radiology Department (Women's Imaging unit), Kasr ElAiny Hospital, Cairo University, Egypt.
authors.forename: Rasha
authors.initials: R
authors.lastname: Mohamed Kamal
authors.affiliation: Radiology Department (Breast Imaging unit), National Cancer Institute, Cairo University, Egypt.
authors.forename: Maha
authors.initials: M
authors.lastname: Hussien Helal
authors.affiliation: Radiology Department (Women's Imaging unit), Kasr ElAiny Hospital, Cairo University, Egypt.
authors.forename: Rasha
authors.initials: R
authors.lastname: Wessam
authors.affiliation: Radiology Department (Breast Imaging unit), National Cancer Institute, Cairo University, Egypt. Electronic address: sahar_mnsr@yahoo.com.
authors.forename: Sahar
authors.initials: S
authors.lastname: Mahmoud Mansour
authors.affiliation: Pathology Department, National Cancer Institute, Cairo University, Egypt.
authors.forename: Iman
authors.initials: I
authors.lastname: Godda
authors.affiliation: Statistics Department, National Cancer Institute, Cairo University, Egypt.
authors.forename: Nelly
authors.initials: N
authors.lastname: Alieldin
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Breast lesions; Contrast-enhanced spectral mammography; Digital mammography; Morphology lexicon