Breast masses with rim enhancement on contrast-enhanced mammography: morphological and enhancement features for diagnosis and differentiation of benign and malignant.

Objectives: To investigate the imaging characteristics and clinicopathological features of rim enhancement of breast masses demonstrated on contrast-enhanced mammography (CEM).

Methods: 67 cases of breast lesions confirmed by pathology and showing rim enhancement on CEM examinations were analyzed. The lesions were divided into benign and malignant groups, and the morphological and enhanced features were described. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated separately for each morphology descriptor to evaluate the diagnostic ability of each indicator.

Results: There were 35 (52.2%) malignant and 32 (47.8%) benign lesions. There are significant differences in the morphological and enhanced features between benign and malignant lesions. 29/35 (82.9%) malignant lesions exhibited irregular shapes, and 31/35 (88.6%) showed indistinct margins. 28/35 (80%) malignant lesions displayed strong enhancement on CEM, while 12/32 (37.5%) benign lesions exhibited weak enhancement (P = 0.001). Malignant lesions showed a higher incidence of unsmooth inner walls than benign lesions (28/35 vs 7/32; P <.001). Lesion margins showed high sensitivity of 88.57% and NPV of 81.8%. The presence of suspicious calcifications had the highest specificity of 100% and PPV of 100%. The diagnostic sensitivity, specificity, PPV, and NPV of the combined parameters were 97.14%, 93.15%, 94.44%, and 96.77%, respectively.

Conclusions: The assessment of morphological and enhanced features of breast lesions exhibiting rim enhancement on CEM can improve the differentiation between benign and malignant breast lesions.

Advances in knowledge: This article provides a reference for the differential diagnosis of ring enhanced lesions on CEM.