title: Adding the power of iodinated contrast media to the credibility of mammography in breast cancer diagnosis.
abstract: Dual-energy contrast-enhanced spectral mammography (CESM) represents a relatively new diagnostic tool adjunct to mammography. The aim of this study was to strengthen the breast imaging-reporting and data system (BIRADS) classification score in order to improve early breast cancer diagnosis. For this reason, we propose a sum score, termed malignancy potential score (MPS), incorporating the standard BIRADS score and our proposed CESM score. From September 2014 to September 2015, 216 females (age range, 26-85 years; mean age 54.6 years) underwent CESM evaluation of mammographic findings that were primarily assessed as BIRADS 2-5. 10 of these patients had bilateral findings; a total of 226 lesions were examined. High-energy image evaluation was based on the intensity of contrast enhancement of the lesion compared with background enhancement, categorized as Type -1, 0, 1 or 2 enhancement. Histopathology reports were compared with imaging assessment. 98 of 226 lesions were malignant and 128 of 226 lesions were benign. The area under the curve was 0.843, 0.888 and 0.917 for mammographic BIRADS score, CESM score and MPS, respectively, with p-value < 0.05. The sensitivity, specificity and accuracy rates were 91.83, 80.47 and 85.40%, respectively, when a best MPS cut-off point of 4 was used. The malignancy potential score (MPS) has higher diagnostic performance than digital mammography or CESM alone. MPS empowers the credibility of the digital mammography BIRADS score and our proposed type of enhancement in dual-energy CESM and is a diagnostic tool that increases the accuracy rate in early breast cancer diagnosis.
authors.affiliation: 1 Breast Unit, 1st Department of Ob/Gyn Athens University Medical School, Alexandra Hospital, Athens, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Tsigginou
authors.affiliation: 2 Department of Radiology, Alexandra Hospital, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Gkali
authors.affiliation: 2 Department of Radiology, Alexandra Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Chalazonitis
authors.affiliation: 2 Department of Radiology, Alexandra Hospital, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Feida
authors.affiliation: 3 Gynecological Oncology Unit, 1st Department of Ob/Gyn Athens University Medical School, Alexandra Hospital, Athens, Greece.
authors.forename: Dimitrios Efthymios
authors.initials: DE
authors.lastname: Vlachos
authors.affiliation: 4 Department of Clinical Therapeutics, Alexandra Hospital, University of Athens.
authors.forename: Flora
authors.initials: F
authors.lastname: Zagouri
authors.affiliation: 1 Breast Unit, 1st Department of Ob/Gyn Athens University Medical School, Alexandra Hospital, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Rellias
authors.affiliation: 1 Breast Unit, 1st Department of Ob/Gyn Athens University Medical School, Alexandra Hospital, Athens, Greece.
authors.forename: Constantine
authors.initials: C
authors.lastname: Dimitrakakis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide