title: Differentiation of ductal carcinoma in-situ from benign micro-calcifications by dedicated breast computed tomography.
abstract: OBJECTIVE
  Compare conspicuity of ductal carcinoma in-situ (DCIS) to benign calcifications on unenhanced (bCT), contrast-enhanced dedicated breast CT (CEbCT) and mammography (DM).
  
  
  METHODS
  The institutional review board approved this HIPAA-compliant study. 42 women with Breast Imaging Reporting and Data System 4 or 5 category micro-calcifications had breast CT before biopsy. Three subjects with invasive disease at surgery were excluded. Two breast radiologists independently compared lesion conspicuity scores (CS) for CEbCT, to bCT and DM. Enhancement was measured in Hounsfield units (HU). Mean CS ± standard deviations are shown. Receiver operating characteristic analysis (ROC) measured radiologists' discrimination performance by comparing CS to enhancement alone. Statistical measurements were made using ANOVA F-test, Wilcoxon rank-sum test and robust linear regression analyses.
  
  
  RESULTS
  39 lesions (17 DCIS, 22 benign) were analyzed. DCIS (8.5 ± 0.9, n=17) was more conspicuous than benign micro-calcifications (3.6 ± 2.9, n=22; p<0.0001) on CEbCT. DCIS was equally conspicuous on CEbCT and DM (8.5 ± 0.9, 8.7 ± 0.8, n=17; p=0.85) and more conspicuous when compared to bCT (5.3 ± 2.6, n=17; p<0.001). All DCIS enhanced; mean enhancement (90HU ± 53HU, n=17) was higher compared to benign lesions (33 ± 30HU, n=22) (p<0.0001). ROC analysis of the radiologists' CS showed high discrimination performance (AUC=0.94) compared to enhancement alone (AUC=0.85) (p<0.026).
  
  
  CONCLUSIONS
  DCIS is more conspicuous than benign micro-calcifications on CEbCT. DCIS visualization on CEbCT is equal to mammography but improved compared to bCT. Radiologists' discrimination performance using CEBCT is significantly higher than enhancement values alone. CEbCT may have an advantage over mammography by reducing false positive examinations when calcifications are analyzed.
authors.affiliation: Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States. Electronic address: sshakeri@ucdavis.edu.
authors.forename: Shadi
authors.initials: S
authors.lastname: Aminololama-Shakeri
authors.affiliation: Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA 93106, United States.
authors.forename: Craig K
authors.initials: CK
authors.lastname: Abbey
authors.affiliation: Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States.
authors.forename: Peymon
authors.initials: P
authors.lastname: Gazi
authors.affiliation: Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States.
authors.forename: Nicolas D
authors.initials: ND
authors.lastname: Prionas
authors.affiliation: Center for Devices and Radiological Heath, Food and Drug Administration, Wash DC, United States.
authors.forename: Anita
authors.initials: A
authors.lastname: Nosratieh
authors.affiliation: Department of Public Health Sciences, Division of Biostatistics, MS1C Room 145, University of California, Davis, CA 95616, United States.
authors.forename: Chin-Shang
authors.initials: CS
authors.lastname: Li
authors.affiliation: Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States.
authors.forename: John M
authors.initials: JM
authors.lastname: Boone
authors.affiliation: Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Lindfors
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D012044:Regression Analysis; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Breast CT; Contrast enhanced breast CT; DCIS; Ductal carcinoma in-situ; Micro calcifications