title: Clinical study of contrast-enhanced digital mammography and the evaluation of blood and lymphatic microvessel density.
abstract: OBJECTIVE
  To correlate image parameters in contrast-enhanced digital mammography (CEDM) with blood and lymphatic microvessel density (MVD).
  
  
  METHODS
  18 Breast Imaging-Reporting and Data System (BI-RADS)-4 to BI-RADS-5 patients were subjected to CEDM. Craniocaudal views were acquired, two views (low and high energy) before iodine contrast medium (CM) injection and four views (high energy) 1-5 min afterwards. Processing included registration and two subtraction modalities, traditional single-energy temporal (high-energy) and "dual-energy temporal with a matrix", proposed to improve lesion conspicuity. Images were calibrated into iodine thickness, and iodine uptake, contrast, time-intensity and time-contrast kinetic curves were quantified. Image indicators were compared with MVD evaluated by anti-CD105 and anti-podoplanin (D2-40) immunohistochemistry.
  
  
  RESULTS
  11 lesions were cancerous and 7 were benign. CEDM subtraction strongly increased conspicuity of lesions enhanced by iodine uptake. A strong correlation was observed between lymphatic vessels and blood vessels; all benign lesions had <30 blood microvessels per field, and all cancers had more than this value. MVD showed no correlation with iodine uptake, nor with contrast. The most frequent curve was early uptake followed by plateau for uptake and contrast in benign and malignant lesions. The positive-predictive value of uptake dynamics was 73% and that of contrast was 64%.
  
  
  CONCLUSIONS
  CEDM increased lesion visibility and showed additional features compared with conventional mammography. Lack of correlation between image parameters and MVD is probably due to tumour tissue heterogeneity, mammography projective nature and/or dependence of extracellular iodine irrigation on tissue composition.
  
  
  CONCLUSIONS
  Quantitative analysis of CEDM images was performed. Image parameters and MVD showed no correlation. Probably, this is indication of the complex dependence of CM perfusion on tumour microenvironment.
authors.affiliation: 1 Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: María-Ester
authors.identifier: http://orcid.org/0000-0002-1165-3440
authors.initials: ME
authors.lastname: Brandan
authors.affiliation: 1 Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cruz-Bastida
authors.affiliation: 1 Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Iván M
authors.initials: IM
authors.lastname: Rosado-Méndez
authors.affiliation: 2 Instituto Nacional de Cancerología, Mexico City, Mexico.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Villaseñor-Navarro
authors.affiliation: 1 Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Héctor
authors.initials: H
authors.lastname: Pérez-Ponce
authors.affiliation: 2 Instituto Nacional de Cancerología, Mexico City, Mexico.
authors.forename: Héctor A
authors.initials: HA
authors.lastname: Galván
authors.affiliation: 3 Hospital Regional de Alta Especialidad de Oaxaca, OAX, Mexico.
authors.forename: Flavio E
authors.initials: FE
authors.lastname: Trujillo-Zamudio
authors.affiliation: 4 Hospital de Oncología, Centro Médico Nacional SXXI, Mexico City, Mexico.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sánchez-Suárez
authors.affiliation: 4 Hospital de Oncología, Centro Médico Nacional SXXI, Mexico City, Mexico.
authors.forename: Luis
authors.initials: L
authors.lastname: Benítez-Bribiesca
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D042601:Lymphatic Vessels / Q000473:pathology*; D008327:Mammography / Q000379:methods*; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged
chemical_list: D003287:Contrast Media