High diagnostic performance of architectural distortion enhancement on CEM for predicting malignant breast lesions

Abstract

Introduction: The usefulness of contrast enhanced mammography (CEM) for assessing architectural distortion (AD) has not been defined. This study aimed to determine the diagnostic accuracy of AD enhancement on CEM for predicting malignancy and its histopathologic correlation. Material and methods: Patients with AD detected on 2D mammography, tomosynthesis (DBT), and/or ultrasound with BI-RADS categories 4 and 5 and supplementary evaluation with CEM were included. Histopathologic confirmation of the diagnosis or 24-month follow-up imaging studies to determine stability were reported. The risk of malignancy with AD enhancement was assessed with odds ratios (OR) with 95% confidence intervals (CI). Sensitivity, specificity, PPV, NPV, and accuracy of AD enhancement for predicting malignancy were calculated. Results: Forty-nine patients with 50 AD lesions (one patient had two AD lesions) were included. Twenty-nine (58.0%) were benign AD lesions, 5 (10.0%) were benign with upgrade potential (BWUP) lesions, and 16 (32.0%) were malignant. AD enhancement on CEM was observed in all breast malignancy cases (n = 16, 100%), compared to 12 (41.4%) of 29 benign ADs (p < 0.001). The risk of malignancy with AD enhancement on CEM was OR = 23.54 (95% CI, 2.77 to 199.9). AD enhancement on CEM had a sensitivity of 95.2% (95% CI, 76.2 to 99.9) and a specificity of 58.6% (95% CI 38.9 to 76.5) for predicting malignancy. The PPV was 69.7 (95% CI, 59.6 to 78.2), the NPV was 92.5% (95% CI, 63.9 to 98.8), and diagnostic accuracy was 76.9% (95% CI, 62.8 to 87.6). Conclusion: AD enhancement on CEM has high diagnostic accuracy for predicting breast malignancy. This study is the first in Mexico to present the experience with CEM in the evaluation of AD.

Keywords

• Architectural distortion. Contrast enhanced mammography. Mammography. Ultrasound. Breast malignancy.