Quantitative analysis of breast lesions on contrast-enhanced mammography and comparison with histopathological results

BackgroundContrast-enhanced mammography (CEM) is a promising and emerging digital mammography technique that improves diagnostic performance.PurposeTo quantitatively evaluate breast lesions on CEM and to investigate the effectiveness of CEM in differentiating benign lesions from malignancies. The secondary aim was to evaluate the effectiveness in lesion characterization of quantitative parameters derived from CEM, specifically relative signal density (RSD) and relative signal change (RSC).Material and MethodsA retrospective analysis was conducted of 170 lesions in 164 female patients who underwent CEM. Lesions were grouped as benign, non-infiltrating, and infiltrating cancer. RSD between lesion and background, including fatty and glandular tissue, was measured. RSCs between former (CC) and latter (MLO) images were calculated and contrast enhancement patterns were obtained. The association between CEM values and pathological results was analyzed.ResultsRelative signal differences on both CC and MLO CEM views showed higher relative signal density in infiltrating tumors than benign ones regardless of whether glandular tissue or fat tissue was used in proportion while different infiltrating malignant subgroups showed no statistical significance according to quantitative analysis (<i>P</i> < 0.001). No significant differences in contrast enhancement patterns (ascending, steady, and descending) were seen either between benign and malignant groups or among malignant subtypes.ConclusionCEM can be used to distinguish between benign and malignant breast lesions, regardless of fat or glandular tissue. However, no difference was observed between benign and malignant lesions according to the contrast-enhancement patterns. Therefore, contrast enhancement patterns in CEM and breast MRI may differ.