title: Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis.
abstract: OBJECTIVE
  To assess the utility of dual-energy contrast-enhanced spectral mammography (DE-CESM) for evaluation of suspicious malignant microcalcifications.
  
  
  METHODS
  Two hundred and fifty-six DE-CESMs were reviewed from 2012-2013, 59 cases fulfilled the following criteria and were enrolled for analysis: (1) suspicious malignant microcalcifications (BI-RADS 4) on mammogram, (2) no related mass, (3) with pathological diagnoses. The microcalcification morphology and associated enhancement were reviewed to analyse the accuracy of the diagnosis and cancer size measurements versus the results of pathology.
  
  
  RESULTS
  Of the 59 microcalcifications, 22 were diagnosed as cancers, 19 were atypical lesions and 18 were benign lesions. Twenty (76.9 %) cancers, three (11.55 %) atypia and three (11.55 %) benign lesions revealed enhancement. The true-positive rate of intermediate- and high-concern microcalcifications was significantly higher than that of low-concern lesions (93.75 % vs. 50 %). Overall, the diagnostic sensitivity of enhancement was 90.9 %, with 83.78 % specificity, 76.92 % positive predictive value, 93.94 % negative predictive value and 86.4 % accuracy. Performance was good (AUC = 0.87) according to a ROC curve and cancer size correlation with a mean difference of 0.05 cm on a Bland-Altman plot.
  
  
  CONCLUSIONS
  DE-CESM provides additional enhancement information for diagnosing breast microcalcifications and measuring cancer sizes with high correlation to surgicohistology.
  
  
  CONCLUSIONS
  • DE-CESM provides additional enhancement information for diagnosing suspicious breast microcalcifications. • The enhanced cancer size closely correlates to microscopy by Bland-Altman plot. • DE-CESM could be considered for evaluation of suspicious malignant microcalcifications.
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Tao Yuan and Linkuo, Medical College of Chang Gung University, 5 Fuxing Street, Guishan Township, Taoyuan County, Taiwan. alex2143@ms33.hinet.net.|Medical Collage of Chang Gung University, Taoyuan, Taiwan. alex2143@ms33.hinet.net.
authors.forename: Yun-Chung
authors.initials: YC
authors.lastname: Cheung
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan.|Medical Collage of Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsiu-Pei
authors.initials: HP
authors.lastname: Tsai
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan.|Medical Collage of Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yung-Feng
authors.initials: YF
authors.lastname: Lo
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan.
authors.forename: Shir-Hwa
authors.initials: SH
authors.lastname: Ueng
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Tao Yuan and Linkuo, Medical College of Chang Gung University, 5 Fuxing Street, Guishan Township, Taoyuan County, Taiwan.
authors.forename: Pei-Chin
authors.initials: PC
authors.lastname: Huang
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan.|Medical Collage of Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shin-Chih
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Breast cancer; Breast microcalcification; Dual-energy Contrast-enhanced Spectral Mammography; Mammography; Surgical planning