Contrast-Enhanced Mammography in Breast Lesion Assessment: Accuracy and Surgical Impact.

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Tomography Pub Date : 2025-08-20 DOI:10.3390/tomography11080093

Graziella Di Grezia, Sara Mercogliano, Luca Marinelli, Antonio Nazzaro, Alessandro Galiano, Elisa Cisternino, Gianluca Gatta, Vincenzo Cuccurullo, Mariano Scaglione

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Abstract

Background: Accurate preoperative tumor sizing is critical for optimal surgical planning in breast cancer. Contrast-enhanced mammography (CEM) has emerged as a promising modality, yet its accuracy relative to conventional imaging and pathology requires further validation.

Objective: To prospectively evaluate the dimensional accuracy and reproducibility of CEM compared to mammography and ultrasound, using surgical pathology as the reference standard.

Methods: A total of 205 patients with 267 breast lesions underwent preoperative CEM, mammography, and ultrasound. Tumor sizes were measured independently by two radiologists. Accuracy was assessed via mean absolute error (MAE), Pearson and Spearman correlations, and inter-reader agreement evaluated by intraclass correlation coefficient (ICC) and Gwet's AC1. Sensitivity analyses included bootstrap confidence intervals and log-transformed data. The surgical impact of additional lesions detected by CEM was also analyzed.

Results: CEM showed superior accuracy with a mean absolute error of 0.46 mm (95% CI: 0.24-0.68) compared to mammography (4.06 mm) and ultrasound (3.52 mm) (p < 0.00001). Pearson's correlation between CEM and pathology was exceptionally high (r = 0.995; 95% CI: 0.994-0.996), with similar robustness after log transformation. Inter-reader agreement for CEM was excellent (ICC 0.93; Gwet's AC1 ~0.96, 95% CI: 0.93-0.98). CEM detected additional lesions in 13.1% of patients, leading to altered surgical management in 6.4%. Background parenchymal enhancement was independently associated with measurement error.

Conclusions: CEM provides highly accurate and reproducible tumor size estimation superior to conventional imaging modalities, with potential clinical impact through detection of additional lesions. Its ability to detect additional lesions not seen on mammography or ultrasound has direct implications for surgical decision making, with the potential to reduce reoperations and improve oncologic and cosmetic outcomes. However, high correlation values and selective patient cohorts warrant cautious interpretation. Further multicenter studies are needed to confirm these findings and define CEM's role in clinical practice.

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对比增强乳房x光检查在乳腺病变评估中的准确性和手术影响。

背景：准确的术前肿瘤大小对乳腺癌的最佳手术计划至关重要。对比增强乳房x线摄影（CEM）已成为一种有前途的方式，但其相对于传统成像和病理的准确性需要进一步验证。目的：以外科病理为参考标准，前瞻性评价超声造影与乳腺x线和超声的尺寸准确性和再现性。方法：205例267个乳腺病变患者术前行超声造影、x光检查和超声检查。肿瘤大小由两名放射科医生独立测量。准确性通过平均绝对误差（MAE）、Pearson和Spearman相关性评估，读者间一致性通过类内相关系数（ICC）和Gwet的AC1评估。敏感性分析包括自举置信区间和对数转换数据。我们还分析了扫描电镜检测到的其他病变对手术的影响。结果：CEM的平均绝对误差为0.46 mm (95% CI: 0.24-0.68)，高于乳房x光检查（4.06 mm）和超声检查（3.52 mm）（p < 0.00001）。CEM与病理之间的Pearson相关性异常高（r = 0.995; 95% CI: 0.994-0.996），经对数变换后具有相似的稳健性。CEM的读者间一致性非常好（ICC 0.93； Gwet的AC1 ~0.96, 95% CI: 0.93-0.98）。在13.1%的患者中，CEM检测到额外的病变，导致6.4%的患者改变手术处理。背景实质增强与测量误差独立相关。结论：与传统成像方式相比，CEM提供了高度准确和可重复的肿瘤大小估计，通过检测其他病变具有潜在的临床影响。它能够检测到乳房x光检查或超声检查没有发现的额外病变，这对手术决策有直接的影响，有可能减少再手术，改善肿瘤和美容结果。然而，高相关性值和选择性患者队列需要谨慎解释。需要进一步的多中心研究来证实这些发现，并确定CEM在临床实践中的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Tomography Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

2.70

自引率

10.50%

发文量

222

期刊介绍： TomographyTM publishes basic (technical and pre-clinical) and clinical scientific articles which involve the advancement of imaging technologies. Tomography encompasses studies that use single or multiple imaging modalities including for example CT, US, PET, SPECT, MR and hyperpolarization technologies, as well as optical modalities (i.e. bioluminescence, photoacoustic, endomicroscopy, fiber optic imaging and optical computed tomography) in basic sciences, engineering, preclinical and clinical medicine. Tomography also welcomes studies involving exploration and refinement of contrast mechanisms and image-derived metrics within and across modalities toward the development of novel imaging probes for image-based feedback and intervention. The use of imaging in biology and medicine provides unparalleled opportunities to noninvasively interrogate tissues to obtain real-time dynamic and quantitative information required for diagnosis and response to interventions and to follow evolving pathological conditions. As multi-modal studies and the complexities of imaging technologies themselves are ever increasing to provide advanced information to scientists and clinicians. Tomography provides a unique publication venue allowing investigators the opportunity to more precisely communicate integrated findings related to the diverse and heterogeneous features associated with underlying anatomical, physiological, functional, metabolic and molecular genetic activities of normal and diseased tissue. Thus Tomography publishes peer-reviewed articles which involve the broad use of imaging of any tissue and disease type including both preclinical and clinical investigations. In addition, hardware/software along with chemical and molecular probe advances are welcome as they are deemed to significantly contribute towards the long-term goal of improving the overall impact of imaging on scientific and clinical discovery.