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Title: Diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM): a retrospective study involving 644 breast lesions
Authors: Travieso-Aja, María del Mar
Maldonado-Saluzzi, Daniel
Naranjo-Santana, Pedro
Fernández-Ruiz, Claudia
Severino-Rondón, Wilsa
Rodríguez Rodríguez, Mario
Vega Benítez, Víctor Manuel 
Pérez-Luzardo, Octavio 
UNESCO Clasification: 32 Ciencias médicas
Keywords: Breast Cancer
Breast Ultrasound
Contrast-Enhanced Dual-Energy Spectral Mammography (Cesm)
Digital Mammography
Iodinated Contrast Medium
Issue Date: 2019
Journal: Radiologia Medica 
Abstract: Objective: To evaluate the diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM) in comparison with that of full-field digital mammography (FFDM), either alone or accompanied with breast ultrasound (BUS) in a large series of patients/breast lesions (n = 644). Patients and methods: In this retrospective study, five radiologists evaluated the lesions by three imaging modalities: FFDM, FFDM + BUS, and CESM and compared the imaging to the gold standard (histopathology or clinical follow-up). Diagnostic performance parameters and receiver operating characteristic (ROC) curves of CESM were calculated and compared to those of FFDM or FFDM + BUS (McNemar’s test). Additionally, the reliability of tumor size measurement by CESM was compared with the histopathological measurement. Results: The study included 218 benign and 426 malignant lesions. 85% of benign and 93% of malignant lesions were adequately identified using CESM. With respect to FFDM and FFDM + BUS, CESM significantly increased sensitivity to 93.2% (+ 10.7% and + 3.4%, respectively); specificity to 84.4% (+ 15.8% and + 1.7%, respectively); PPV to 92.3% (+ 26.8% and + 3.6%, respectively); NPV to 86.0% (+ 1.6% and + 1.8%, respectively); and accuracy to 90.2% (+ 15.8% and + 3.2%, respectively). In the ROC curves analyses, the comparison among the three AUC values was also statistically significant (p < 0.001). Good agreement between tumor diameters measured using CESM and histopathology was observed (Spearman’s rank correlation, r = 0.891, p < 0.0001), although this technique tended to produce an overestimation of the size (+ 7 mm). Conclusions: CESM has high diagnostic accuracy and can be considered as a useful technique for the assessment of breast lesions.
ISSN: 0033-8362
DOI: 10.1007/s11547-019-01056-2
Source: Radiologia Medica [ISSN 0033-8362], v. 124 (10), p. 1006-1017
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