A head-to-head comparison of breast lesion's conspicuity at contrast-enhanced mammography and contrast-enhanced MRI

Ambra Santonocito; Calogero Zarcaro; Layla Zeitouni; Francesca Ferrara; Panagiotis Kapetas; Thomas H Helbich; Paola Clauser; Pascal A T Baltzer

doi:10.1007/s00330-024-11195-4

A head-to-head comparison of breast lesion's conspicuity at contrast-enhanced mammography and contrast-enhanced MRI

Eur Radiol. 2024 Dec 3. doi: 10.1007/s00330-024-11195-4. Online ahead of print.

Authors

Ambra Santonocito¹, Calogero Zarcaro², Layla Zeitouni³, Francesca Ferrara⁴, Panagiotis Kapetas^{1

5}, Thomas H Helbich¹, Paola Clauser¹, Pascal A T Baltzer⁶

Affiliations

¹ Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
² Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy.
³ Department of Radiology Section of Breast Imaging King Faisal Specialist Hospital and Research Center Riyadh, Riyadh, Saudi Arabia.
⁴ Catholic University of the Sacred Heart, Institute of Radiology, Largo A. Gemelli 8, 00168, Rome, Italy.
⁵ Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.
⁶ Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. patbaltzer@gmail.com.

PMID: 39625504
DOI: 10.1007/s00330-024-11195-4

Abstract

Purpose: Lesion conspicuity, the relative enhancement of a lesion compared to surrounding tissue, is a new descriptor in the ACR BI-RADS 2022 CEM supplement. We compared lesion conspicuity in contrast-enhanced mammography (CEM) and contrast-enhanced MRI (CE-MRI) in patients with suspicious breast lesions.

Materials and methods: IRB-approved retrospective study; three blinded readers rated 462 indeterminate or suspicious breast lesions in 388 patients (54.2 ± 11 years; range 30-90) who underwent CEM and CE-MRI from 2018 to 2022. Each lesion's conspicuity was scored from 1 to 5, with 5 indicating excellent conspicuity. Visual grading characteristics (VGC) analysis and area under the curve (AUC) were used for comparison, with sub-analyses for benign and malignant lesions.

Results: VGC analysis showed a significant AUC of 0.670 to 0.723 (p < 0.001) favouring CE-MRI. No lesion enhancement (score 1) was observed in 16.2% of CE-MRI and 44.7% of CEM. Excellent conspicuity was seen in 29.6% of CE-MRI and 11.9% of CEM. Sub-analysis showed higher conspicuity on CE-MRI for both malignant (AUC 0.665 to 0.732, p < 0.001) and benign lesions (AUC 0.734 to 0.798, p < 0.001). CE-MRI showed higher lesion conspicuity compared to CEM both for non-mass lesions (0.656) and for mass lesions 0.605.

Conclusion: CE-MRI shows significantly higher conspicuity for benign and malignant breast lesions compared to CEM, especially for benign lesions. The low conspicuity of benign lesions on CEM may help reduce false positives in clinical practice.

Key points: Question Lesion conspicuity is a new descriptor for lesion enhancement according to the new CEM lexicon. Data correlating lesion conspicuity with malignancy likelihood are limited. Findings Lesion conspicuity is higher for contrast-enhanced-MRI than for contrast-enhanced mammography (CEM) for all lesions but significantly better for benign lesions. Clinical relevance The low conspicuity of benign lesions on CEM may reduce false-positive results, making it a valuable tool in breast cancer screening.

Keywords: Breast cancer; Cancer screening; Image quality enhancement; Sensitivity and specificity.

Abstract

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