Contrast-enhanced spectral mammography (CESM) versus breast magnetic resonance imaging (MRI): A retrospective comparison in 66 breast lesions.
OBJECTIVE
The purpose of this study was to retrospectively compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) with that of breast magnetic resonance imaging (BMRI) in breast cancer detection using parameters, including sensitivity, positive predictive value (PPV), lesion size, morphology, lesion and background enhancement, and examination time.


METHODS
A total of 48 women (mean age, 56years±10.6 [SD]) with breast lesions detected between October 2012 and March 2014 were included. Both CESM and BMRI were performed for each patient within 30 days. The enhancement intensity of lesions and breast background parenchyma was subjectively assessed for both modalities and was quantified for comparison. Statistical significance was analyzed using paired t-test for mean size of index lesions in all malignant breasts (an index lesion defined as the largest lesion in each breast), and a mean score of enhancement intensity for index lesions and breast background. PPV, sensitivity, and accuracy were calculated for both CESM and BMRI. The average duration time of CESM and MRI examinations was also compared.


RESULTS
A total of 66 lesions were identified, including 62 malignant and 4 benign lesions. Both CESM and BMRI demonstrated a sensitivity of 100% for detection of breast cancer. There was no statistically significant difference between the mean size of index lesions (P=0.108). The enhancement intensity of breast background was significantly lower for CESM than for BMRI (P<0.01). The mean score of enhancement intensity of index lesions on CESM was significantly less than that for BMRI (P<0.01). The smallest lesion that was detected by both modalities measured 4mm. CESM had a higher PPV than BMRI (P>0.05). The average examination time for CESM was significantly shorter than that of BMRI (P<0.01).


CONCLUSIONS
CESM has similar sensitivity than BMRI in breast cancer detection, with higher PPV and less background enhancement. CESM is associate with significantly shorter exam time thus a more accessible alternative to BMRI, and has the potential to play an important tool in breast cancer detection and staging.
Department of Radiology, Cooper University Hospital, 900 Centennial Blvd., Building 1, Suite B, Voorhees, NJ 08043, USA. Electronic address: li-luna@cooperhealth.edu.
L
L
Li
Department of Radiology, Cooper University Hospital, 900 Centennial Blvd., Building 1, Suite B, Voorhees, NJ 08043, USA. Electronic address: roth-robyn@CooperHealth.edu.
R
R
Roth
Department of Radiology, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08013, USA. Electronic address: germaine-pauline@CooperHealth.edu.
P
P
Germaine
Department of Pathology, Cooper University Hospital, , One Cooper Plaza, Camden, NJ 08013, USA. Electronic address: ren-shuyue@CooperHealth.edu.
S
S
Ren
Department of Radiology, Cooper University Hospital, 900 Centennial Blvd., Building 1, Suite B, Voorhees, NJ 08043, USA. Electronic address: Lee-Michael-J@CooperHealth.edu.
M
M
Lee
Cooper Medical School of Rowan University; Statistician II, Cooper Research Institute, Cooper University Hospital, 401 Haddon Ave., Room 140, Camden, NJ 08103, USA. Electronic address: hunter-krystal@CooperHealth.edu.
K
K
Hunter
Cooper University Hospital, Department of Radiology, 900 Centennial Blvd., Building 1, Suite B, Voorhees, NJ 08043, USA. Electronic address: tinney-elizabeth@CooperHealth.edu.
E
E
Tinney
Cooper Breast Imaging Center, Cooper University Hospital, 900 Centennial Blvd., Building 1, Suite B, Voorhees, NJ 08043, USA. Electronic address: Dr.Lydia.liao@gmail.com.
L
L
Liao
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002277:Carcinoma / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007479:Iopamidol; D008279:Magnetic Resonance Imaging; D008327:Mammography / Q000379:methods*; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; D007479:Iopamidol
Breast cancer diagnosis; Comparative studies; Contrast-enhanced spectral mammography (CESM); Magnetic resonance imaging (MRI)