BREAST RADIOLOGY / ORIGINAL PAPER
Comparative analysis of diagnostic performance of automatic breast ultrasound and spectral mammography as complementary methods to mammography examination
1
Department of Radiology, University Hospital in Cracow, Cracow, Poland
2
Department of Electroradiology, Jagiellonian University Medical College, Cracow, Poland
3
Chair of Radiology, Jagiellonian University Medical College, Cracow, Poland
Submission date: 2024-10-14
Final revision date: 2024-12-31
Acceptance date: 2025-01-03
Publication date: 2025-02-03
Corresponding author
Wojciech Rudnicki
Department of Electroradiology, Jagiellonian University Medical College, Cracow, Poland
Department of Electroradiology, Jagiellonian University Medical College, Cracow, Poland
Pol J Radiol, 2025; 90: 55-65
KEYWORDS
TOPICS
ABSTRACT
Purpose:
This single-centre study includes a comparative analysis of the diagnostic performance of contrast-enhanced mammography (CEM) and automatic breast ultrasound (ABUS). The study involved 81 patients with focal breast lesions, who underwent ABUS, full-field digital mammography (FFDM), and CEM.
Material and methods:
A total of 169 focal lesions were found in 81 patients, of which 110 lesions were histopathologically verified, 92 were malignant, 5 were B3 lesions, and 13 were benign. On CEM 19 additional lesions not visible on other imaging examinations were found, and as many as 36 new lesions were detected on ABUS. The number of lesions detected in patients with multiple lesions were 106 from 169 on ABUS, 65 on FFDM, and 88 on CEM. The highest correlation between the lesion’s margin and its histopathological character was found in FFDM (p < 0.00), then ABUS (p = 0.038), and the lowest in CEM (p = 0.043). Compliance in determining the lesions’ size comparing to histopathology as a gold standard was the highest for ABUS (p = 0.258) and lower for CEM (p = 0.012).
Results:
The sensitivity of ABUS, FFDM, and CEM was, respectively: 80.43, 90.22, and 93.48; specificity: 27.78, 11.11, and 11.11; positive predictive value (PPV): 85.06, 83.84, and 84.31; negative predictive value (NPV): 21.74, 18.18, and 25; and accuracy: 71.82, 77.27, and 80. The sensitivity and accuracy of the combination of FFDM and ABUS were, respectively, 100 (p = 0.02) and 84.55 (AUC = 0.947) and for the combination of FFDM + CEM 93.48 (p = 0.25) and 79.09 (AUC = 0.855).
Conclusions:
The study confirms that both ABUS and CEM may serve as a valuable complementary method for FFDM.
This single-centre study includes a comparative analysis of the diagnostic performance of contrast-enhanced mammography (CEM) and automatic breast ultrasound (ABUS). The study involved 81 patients with focal breast lesions, who underwent ABUS, full-field digital mammography (FFDM), and CEM.
Material and methods:
A total of 169 focal lesions were found in 81 patients, of which 110 lesions were histopathologically verified, 92 were malignant, 5 were B3 lesions, and 13 were benign. On CEM 19 additional lesions not visible on other imaging examinations were found, and as many as 36 new lesions were detected on ABUS. The number of lesions detected in patients with multiple lesions were 106 from 169 on ABUS, 65 on FFDM, and 88 on CEM. The highest correlation between the lesion’s margin and its histopathological character was found in FFDM (p < 0.00), then ABUS (p = 0.038), and the lowest in CEM (p = 0.043). Compliance in determining the lesions’ size comparing to histopathology as a gold standard was the highest for ABUS (p = 0.258) and lower for CEM (p = 0.012).
Results:
The sensitivity of ABUS, FFDM, and CEM was, respectively: 80.43, 90.22, and 93.48; specificity: 27.78, 11.11, and 11.11; positive predictive value (PPV): 85.06, 83.84, and 84.31; negative predictive value (NPV): 21.74, 18.18, and 25; and accuracy: 71.82, 77.27, and 80. The sensitivity and accuracy of the combination of FFDM and ABUS were, respectively, 100 (p = 0.02) and 84.55 (AUC = 0.947) and for the combination of FFDM + CEM 93.48 (p = 0.25) and 79.09 (AUC = 0.855).
Conclusions:
The study confirms that both ABUS and CEM may serve as a valuable complementary method for FFDM.
REFERENCES (54)
1.
Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev 2006; 15: 45-51.
2.
Hendrick RE, Smith RA, Rutledge JH, Smart CR. Benefit of screening mammography in women aged 40-49: a new meta-analysis of randomized controlled trials. J Natl Cancer Inst Monogr 1997; 22: 87-92.
3.
Tabár L, Vitak B, Chen HH, Yen MF, Duffy SW, Smith RA. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality. Cancer 2001; 91: 1724-1731.
4.
Duffy SW, Tabár L, Chen HH, Holmqvist M, Yen MF, Abdsalahet S, et al. The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish counties. Cancer 2002; 95: 458-469.
5.
McCormack VA, dos Santos Silva I. Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2006; 15: 1159-1169.
6.
Chiu SY, Duffy S, Yen AM, Tabár L, Smith RA, Chen HH. Effect of baseline breast density on breast cancer incidence, stage, mortality, and screening parameters: 25-year follow-up of a Swedish mammographic screening. Cancer Epidemiol Biomarkers Prev 2010; 19: 1219-1228.
7.
Fallenberg EM, Dromain C, Diekmann F, Renz DM, Amer H, Ingold-Heppner B, et al. Contrast-enhanced spec tral mammography: does mammography provide additional clinical benefits or can some radiation exposure be avoided? Breast Cancer Res Treat 2014; 146: 371-381.
8.
Lalji UC, Jeukens CR, Houben I, Nelemans PJ, van Engen RE, van Wylick E, et al. Evaluation of low- energy contrast-enhanced spectral mammography images by comparing them to full-field digital mammography using EUREF image quality criteria. Eur Radiol 2015; 25: 2813-2820.
9.
Francescone MA, Jochelson MS, Dershaw DD, Sung JS, Hughes MC, Zheng J, et al. Low energy mammogram obtained in contrast-enhanced digital mammography (CEDM) is comparable to routine full-field digital mammography (FFDM). Eur J Radiol 2014; 83: 1350-1355.
11.
Folkman J, Watson K, Ingbr D, Hanahan D. Induction of angiogenesis during the transition from hyperplasia to neoplasia. Nature 1989; 339: 58-61.
12.
Schneider BP, Miller KD. Angiogenesis of breast cancer. J Clin Oncol 2005; 23: 1782-1790.
13.
Pham CD, Roberts TP, van Bruggen N, et al. Magnetic resonance imaging detects suppression of tumor vascular permeability after administration of antibody to vascular endothelial growth factor. Cancer Invest 1998; 16: 225-230.
14.
Cheung YC, Lin YC, Wan YL, Huang PC, Lo YF, Tsai HP, et al. Diagnostic performance of dual-energy contrast-enhanced sub tracted mammography in dense breasts compared to mammog raphy alone: interobserver blind-reading analysis. Eur Radiol 2014; 24: 2394-2403.
15.
Patel B, Garza SA, Eversman S, López-Álvarez YM, Kosiorek HE, Pockaj BA. Assessing tumor extent on contrast-enhanced spectral mammography versus full-field digital mammography and ultrasound. Clin Imaging 2017; 46: 78-84.
16.
Mori M, Akashi-Tanaka S, Suzuki S, Daniels MI, Watanabe C, Hirose M, Nakamura S. Diagnostic accuracy of contrast-enhanced spectral mammography in comparison to conventional full-field digital mammography in a population of women with dense breasts. Breast Cancer 2017; 24: 104-110.
17.
Lobbes MB, Lalji U, Houwers J, Nijssen EC, Nelemans PJ, van Roozendaal L, et al. Contrast-enhanced spectral mammography in patients referred from thebreast cancer screening programme. Eur Radiol 2014; 24: 1668-1676.
18.
Łuczyńska E, Heinze S, Dyczek S, Blecharz P, Ryś J, Reinfuss M. Contrast-enhanced spectral mammography: comparison with conventional mammography and histopathology in 152 women. Korean J Radiol 2014; 15: 689. DOI: 10.3348/kjr.2014.15.6.689.
19.
Feng L, Lei S, Zhang L, Li N, Xie Y. Comparison of contrast-enhanced spectral mammography and contrast-enhanced MRI in screening multifocal and multicentric lesions in breast cancer patients. Contrast Media Mol Imaging 2022; 2022: 4224701. DOI: 10.1155/2022/4224701.
20.
Lee-Felker S, Tekchandani L, Thomas M, Gupta E, Andrews-Tang D, Roth A, et al. Newly diagnosed breast cancer: Comparison of contrast-enhanced spectral mammography and breast MR imaging in the evaluation of extent of disease. Radiology 2017; 285: 389-400.
21.
Fallenberg EM, Schmitzberger FF, Amer H, Ingold-Heppner B, Balleyguier C, Diekmann F, et al. Contrast-enhanced spectral mammography vs. mammography and MRI – clinical performance in a multi-reader evaluation. Eur Radiol 2016; 27: 2752-2764.
22.
Daniaux M, Grüber L, De Zordo T, Geiger-Gritsch S, Amort B, Santner W, et al. Preoperative staging by multimodal imaging in newly diagnosed breast cancer: Diagnostic performance of contrast-enhanced spectral mammography compared to conventional mammography, ultrasound, and MRI. Eur J Radiol 2023; 163: 110838. DOI:10.1016/j.ejrad.2023.110838.
23.
Kuhl C. The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 2007; 244: 356-378.
24.
Vourtsis A. Three-dimensional automated breast ultrasound: technical aspects and first results. Diagn Interv Imaging 2019; 100: 579-592.
25.
Karst I, Henley C, Gottschalk N, Floyd S, Mendelson E. Three-dimensional automated breast US: facts and artifacts. Radiographics 2019; 39: 913-931.
26.
Nicosia L, Ferrari F, Bozzini A, Latronico A, Trentin C, Meneghetti L, et al. Automatic breast ultrasound: state of the art and future perspectives. Ecancermedicalscience 2020; 14: 1062. DOI: 10.3332/ecancer.2020.1062.
27.
Van Zelst J, Platel B, Karssemeijer N, Mann R. Multiplanar reconstructions of 3D automated breast ultrasound improve lesion differentiation by radiologists. Acad Radiol 2015; 22: 1489-1496.
28.
Vourtsis A, Berg W. Breast density implications and supplemental screening. Eur Radiol 2019; 29: 1762-1777.
29.
Yuan W, Hsu H, Chen Y, Wu C. Supplemental breast cancer-screening ultrasonography in women with dense breasts: a systematic review and meta-analysis. Br J Cancer 2020; 123: 673-688.
30.
Brem RF, Tabár L, Duffy SW, Inciardi MF, Guingrich JA, Hashimoto BE, et al. Assessing improvement in detection of breast cancer with three-dimensional automated breast US in women with dense breast tissue: the SomoInsight Study. Radiology 2015; 274: 663-673.
31.
Wilczek B, Wilczek H, Rasouliyan L, Leifland K. Adding 3D automated breast ultrasound to mammography screening in women with heterogeneously and extremely dense breasts: report from a hospital-based, high-volume, single-center breast cancer screening program. Eur J Radiol 2016; 85: 1554-1563.
32.
Covington MF. Contrast-enhanced mammography implementation, performance, and use for supplemental breast cancer screening. Radiol Clin North Am 2021; 59: 113-128.
33.
Gatta G, Cappabianca S, La Forgia D, Massafra R, Fanizzi A, Cuccurullo V, et al. Second-generation 3D automated breast ultrasonography (prone ABUS) for dense breast cancer screening integrated to mammography: effectiveness, performance and detection rates affiliations. J Pers Med 2021; 11: 875. DOI: 10.3390/jpm11090875.
34.
Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97: 695-704.
35.
Patel BK, Lobbes MBI, Lewin J. Contrast enhanced spectral mammography: a review. Semin Ultrasound CT MRI 2018; 39: 70-79.
36.
Lobbes MBI, Smidt ML, Houwers J, Tjan-Heijnen VC, Wildberger JE. Contrast enhanced mammography: techniques, current results and potential indications. Clin Radiol 2013; 68: 935-944.
37.
Drukteinis JS, Mooney B, Flowers CI, Gatenby RA. Beyond mammography: new frontiers in breast cancer screening. Am J Med 2013; 126: 472-479.
38.
Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002; 225: 165-175.
39.
Carney PA, Miglioretti DL, Yankaskas BC, Kerlikowske K, Rosenberg R, Rutter CM, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med 2003; 138: 168-175.
40.
Berg WA. Tailored supplemental screening for breast cancer: what now and what next. AJR Am J Roentgenol 2009; 192: 390-399.
41.
Brekelmans CT, Seynaeve C, Bartels CC, Tilanus-Linthorst MM, Meijers-Heijboer EJ, Crepin CM, et al. Effectiveness of breast cancer surveillance in BRCA1/2 gene mutation carriers and women with high familial risk. J Clin Oncol 2001; 19: 924-930.
42.
Chart PL, Franssen E. Management of women at increased risk for breast cancer: preliminary results from a new program. CMAJ 1997; 157: 1235-1242.
43.
Macmillan RD. Screening women with a family history of breast cancer – results from the British Familial Breast Cancer Group. Eur J Surg Oncol 2000; 26: 149-152.
44.
Scheuer L, Kauff N, Robson M, Kelly B, Barakat R, Satagopan J, et al. Outcome of preventive surgery and screening for breast and ovarian cancer in BRCA mutation carriers. J Clin Oncol 2002; 20: 1260-1268.
45.
Warner E, Plewes DB, Shumak RS, Catzavelos GC, Di Prospero LS, Yaffe MJ, et al. Comparison of breast magnetic resonance imaging, mammography, and ultrasound for surveillance of women at high risk for hereditary breast cancer. J Clin Oncol 2001; 19: 3524-3531.
46.
Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007; 356: 227-236.
47.
Sorin V, Yagil Y, Yosepovich A, Shalmon A, Gotlieb M, Neiman OH, Sklair-Levy M. Contrast enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. AJR Am J Roentgenol 2018; 211: W267-W274. DOI: 10.2214/AJR.17.19355.
48.
Sung JS, Lebron L, Keating D, D’Alessio D, Comstock CE, Lee CH, et al. Performance of dual-energy contrast-enhanced digital mammography for screening women at increased risk of breast cancer. Radiology 2019; 293: 81-88.
49.
Kim G, Mehta TS, Brook A, Du L, Legare K, Phillips J. Enhancement type at contrast-enhanced mammography and association with malignancy. Radiology 2022; 305: 299-306.
50.
Rudnicki W, Heinze S, Niemiec J, Kojs Z, Sas-Korczyńska B, Hendrick EB. Correlation between quantitative assessment of contrast enhancement in contrast-enhanced spectral mammography (CESM) and histopathology – preliminary results. Eur Radiol 2019; 29: 6220-6226.
51.
Cain N, Rahbar G, Park E, Tang M, Andrews-Tang D, Gupta E, et al. Quantitative analysis of contrast-enhanced mammography for risk stratification of benign versus malignant disease and molecular subtype. J Breast Imaging 2022; 4: 496-505.
52.
Xu W, Zheng B, Chen W, Wen C, Zeng H, He Z, et al. Can the delayed phase of quantitative contrast-enhanced mammography improve the diagnostic performance on breast masses? Quant Imaging Med Surg 2021; 11: 3684-3697.
53.
Wang S, Wang Z, Li R, You C, Mao N, Jiang T, et al. Association between quantitative and qualitative image features of contrast-enhanced mammography and molecular subtypes of breast cancer. Quantit Imaging Med Surg 2022; 12: 1270-1280.
54.
Miller MM, Rubaiyat AHM, Rohde GK. Predicting malignancy of breast imaging findings using quantitative analysis of contrastenhanced mammography (CEM). Diagnostics (Basel) 2023; 13: 1129. DOI: 10.3390/diagnostics13061129.
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