Role of Dual Energy Contrast Enhanced Spectral Mammography in Differentiation between Benign and Malignant Breast Masses

Abstract
Background: Dual Energy Contrast Enhanced Spectral Mammography (DE-CESM) is a new and advanced clinical application of full field (FFDM) and is easily implemented, fast, and reproducible, and breast doses are comparable to those of standard digital mammography, it might be useful for shifting expensive MRI to digital mammography.
Aim of Study: To evaluate the enhancing power of the Contrast-Enhanced Spectral Mammography (CESM) on breast lesions and its ability to differentiate malignant from benign masses.
Patients and Methods: A prospective study was carried on 20 patients referred to Radio-Diagnosis Department. At the Air Forces Hospital over 12 months for the evaluation of breast masses, all patients were examined by a dual energy contrast enhanced spectral mammography, a complementary B-mode ultrasound and a histopathological examination of all masses.
Results: The study included 8 benign (40%) and 12 malignant (60%) masses, 17/20 (85%) of them were enhanced while 3/20 (15%) were not enhanced. The enhanced masses were further subdivided into faint & avid enhancement as well as homogenous, heterogeneous & ring enhancement. Contrast uptake was significantly more frequent by malignant masses (p-value <_0.301). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p-value £0.004) DE-CESM was 91.7% sensitive and 87.5% specific. The positive and negative likelihood ratios were 91.7 and 87.5 respectively.
Conclusion: Using CESM to assess the morphology and enhancement characteristics of breast lesions improves the ability of digital mammography to differentiate benign from malignant breast lesions.