The diagnostic value of contrast-enhanced spectral mammography for non-mass enhancement breast cancer

CHEN Jun; GE Jindan; WEI Panpan; YANG Guang; HUA Bei; WANG Yong; RONG Xiaocui; QUAN Guanmin

doi:10.19300/j.2024.L20879

Abstract：Objective To explore the diagnostic value of contrast-enhancement spectral mammography(CESM)features for different histological types of non-mass enhancement(NME)ductal carcinoma of the breast and axillary lymph node(ALN)metastasis.Methods A retrospective study was conducted on 63 female patients with NME breast cancer who underwent CESM and were pathologically diagnosed with ductal carcinoma in situ(DCIS)or invasive ductal carcinoma(IDC).Patients were divided into DCIS group(32 cases)and IDC group(31 cases)based on histological type.Additionally,the DCIS group was subdivided into pure DCIS(18 cases)and DCIS with microinvasion(DCIS-MI)(14 cases).Based on ALN metastasis,patients were categorized into the metastasis-positive group(19 cases)and the metastasis-negative group(44 cases).Differences in CESM imaging features between groups were compared using t-tests,Mann-Whitney U tests,and chi-square tests.Statistically significant CESM imaging features were analyzed using multivariate logistic regression to identify independent predictors of IDC,DCIS-MI,and ALN metastasis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC),sensitivity,and specificity were calculated and compared.Results The%RSCC,TIC,and internal enhancement patterns were significantly different between the DCIS and IDC groups(all P＜0.05).The cross-sectional area,relative enhancement ratio of cycranio caudal subtraction angiograph(%RSCC),and pattern of time-signal intensity curve(TIC)were significantly different between DCIS and DCIS-MI groups(all P＜0.05).The%RSCC,TIC and internal enhancement patterns were significantly different between the ALN metastasis positive and negative groups(all P＜0.05).%RSCC＞3.42%and clustered/ring enhancement were independent predictors of IDC(both P＜0.05),with AUC values of 0.732 and 0.704,respectively.%RSCC＞2.47%and cross-sectional area＞4.37 cm2 were independent predictors of DCIS-MI(both P＜0.05),with the AUC values of 0.802 and 0.764,respectively.%RSCC＞2.71%and clustered/ring enhancement were independent predictors of ALN metastasis(both P＜0.05),with AUC values of 0.717 and 0.786,respectively.Conclusion The%RSCC,cross-sectional area,TIC and internal enhancement patterns characteristics measured on CESM have diagnostic value for histological types and axillary lymph node(ALN)metastasis.These features can provide reference information for clinical decision-making and patient prognosis.