Yun-Chung Cheung MD, Presenter: Nothing to Disclose

Yu-Ching Lin MD, Abstract Co-Author: Nothing to Disclose

Shir-Hwa Ueng, Abstract Co-Author: Nothing to Disclose

Hsiu-Pei Tsai, Abstract Co-Author: Nothing to Disclose

Yung-Feng Lo MD, Abstract Co-Author: Nothing to Disclose

Mammographic impalpable microcalcifications have various probabilities of cancers. This retrospective study was to evaluate the help of enhancement by Dual Energy Contrast-Enhanced Spectral Mammography (DE-CESM) clinically on the concern impalpable breast microcalcifications

Reviewed 256 DE-CESM examinations from 2012 to 2013, 59 sites of pathologic proved impalpable microcalcifications in 52 women (ranged from 30 y/o to 69 y/o, average 48.9 y/o) were enrolled in this study. All the microcalcifications were classified to ACR-BIRADS 4. The DE-CESM was performed standardized with craniocaudal and mediolateral oblique views of bilateral breasts 2 minutes after bolus injection of iodinated contrast medium. The diagnostic profiles for sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. The enhanced appearances and sizes of cancers were reviewed.

Twenty-two microcalcifications (37.3%) were histologic diagnosed to cancers (16 Ductal Carcinoma In Situ (DCIS), 6 Invasive Ductal Carcinoma (IDC)); 19 (32.2%) were atypia lesions (6 Atypical Ductal Hyperplasia, 13 Flat Epitheial Atypia) and 18 (30.5%) were benign. Enhancement was revealed at 27 microcalcifications including 6 IDC (100% of IDC), 14 DCIS (87.5% of DCIS), 4 atypia (21%) and 3 benign lesions (16.7%). However, 2 low grade DCIS were not enhanced. The enhanced cancers appeared as masses in 5, regional in 6, segmental in 4, clump (cluster of foci) in 3 and foci in 2. The diagnosis of enhancement on DE-CESM were 90.9% in sensitivity, 81.1% in specificity, 74% in positive predictive value, 93.75% in negative predictive value and 84.7% in accuracy. The average size of 18 operated cancers was 1.77 cm on subtracted mammograms that was close to 1.72 cm on microscopy.

DE-CESM provides additional information of associate enhancement in diagnosing the impalpable breast microcalcifications, not-perfectly with acceptable sensitivity or negative predictive value. The sizes of enhanced cancers closely related to microscopic size that would help for pre-operative planning.

DE-CESM can evaluate if the concern microcalcifications associating with enhancement and this information helps for dignosis or surgery planning.

Cheung, Y, Lin, Y, Ueng, S, Tsai, H, Lo, Y, Clinical Help of Enhancement by Dual Energy Contrast-enhanced Spectral Mammography on Impalpable Breast Microcalcifications.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001199.html