Margarita L Zuley1, Andriy I Bandos2, Gordon S Abrams3, Marie A Ganott3, Terri-Ann Gizienski3, Christiane M Hakim3, Amy E Kelly3, Bronwyn E Nair3, Jules H Sumkin3, Uzma Waheed3, David Gur4. 1. University of Pittsburgh, School of Medicine & University of Pittsburgh Medical Center, Magee-Womens Hospital, Department of Radiology, Division of Breast Imaging, 300 Halket Street, Pittsburgh PA 15213, USA. Electronic address: zuleyml@upmc.edu. 2. University of Pittsburgh, Graduate School of Public Health, Biostatistics, Pittsburgh Pennsylvania. 3. University of Pittsburgh, School of Medicine & University of Pittsburgh Medical Center, Magee-Womens Hospital, Department of Radiology, Division of Breast Imaging, 300 Halket Street, Pittsburgh PA 15213, USA. 4. University of Pittsburgh, School of Medicine, Department of Radiology, Imaging Research, Pittsburgh Pennsylvania.
Abstract
RATIONALE AND OBJECTIVES: To preliminarily asses if Contrast Enhanced Digital Mammography (CEDM) can accurately reduce biopsy rates for soft tissue BI-RADS 4A or 4B lesions. MATERIALS AND METHODS: Eight radiologists retrospectively and independently reviewed 60 lesions in 54 consenting patients who underwent CEDM under Health Insurance Portability and Accountability Act compliant institutional review board-approved protocols. Readers provided Breast Imaging Reporting & Data System ratings sequentially for digital mammography/digital breast tomosynthesis (DM/DBT), then with ultrasound, then with CEDM for each lesion. Area under the curve (AUC), true positive rates and false positive rates, positive predictive values and negative predictive values were calculated. Statistical analysis accounting for correlation between lesion-examinations and between-reader variability was performed using OR/DBM (for SAS v.3.0), generalized linear mixed model for binary data (proc glimmix, SAS v.9.4, SAS Institute, Cary North Carolina), and bootstrap. RESULTS: The cohort included 49 benign, two high-risk and nine cancerous lesions in 54 women aged 34-74 (average 50) years. Reader-averaged AUC for CEDM was significantly higher than DM/DBT alone (0.85 versus 0.66, p < 0.001) or with US (0.85 versus 0.75, p = 0.001). CEDM increased true positive rates from 0.74 under DB/DBT, and 0.89 with US, to 0.90 with CEDM, (p = 0.019 DM/DBT versus CEDM, p = 0.78 DM/DBT + US versus CEDM) and decreased false positive rates from 0.47 using DM/DBT and 0.61 with US to 0.39 with CEDM (p = 0.017 DM/DBT versus CEDM, p = 0.001 DM/DBT+ US versus CEDM). For an expected cancer rate of 10%, CEDM positive predictive values was 20.5% (95% CI: 16%-27%) and negative predictive values 98.3% (95% CI: 96%-100%). CONCLUSION: Addition of CEDM for evaluation of low-moderate suspicion soft tissue breast lesions can substantially reduce biopsy of benign lesions without compromising cancer detection.
RATIONALE AND OBJECTIVES: To preliminarily asses if Contrast Enhanced Digital Mammography (CEDM) can accurately reduce biopsy rates for soft tissue BI-RADS 4A or 4B lesions. MATERIALS AND METHODS: Eight radiologists retrospectively and independently reviewed 60 lesions in 54 consenting patients who underwent CEDM under Health Insurance Portability and Accountability Act compliant institutional review board-approved protocols. Readers provided Breast Imaging Reporting & Data System ratings sequentially for digital mammography/digital breast tomosynthesis (DM/DBT), then with ultrasound, then with CEDM for each lesion. Area under the curve (AUC), true positive rates and false positive rates, positive predictive values and negative predictive values were calculated. Statistical analysis accounting for correlation between lesion-examinations and between-reader variability was performed using OR/DBM (for SAS v.3.0), generalized linear mixed model for binary data (proc glimmix, SAS v.9.4, SAS Institute, Cary North Carolina), and bootstrap. RESULTS: The cohort included 49 benign, two high-risk and nine cancerous lesions in 54 women aged 34-74 (average 50) years. Reader-averaged AUC for CEDM was significantly higher than DM/DBT alone (0.85 versus 0.66, p < 0.001) or with US (0.85 versus 0.75, p = 0.001). CEDM increased true positive rates from 0.74 under DB/DBT, and 0.89 with US, to 0.90 with CEDM, (p = 0.019 DM/DBT versus CEDM, p = 0.78 DM/DBT + US versus CEDM) and decreased false positive rates from 0.47 using DM/DBT and 0.61 with US to 0.39 with CEDM (p = 0.017 DM/DBT versus CEDM, p = 0.001 DM/DBT+ US versus CEDM). For an expected cancer rate of 10%, CEDM positive predictive values was 20.5% (95% CI: 16%-27%) and negative predictive values 98.3% (95% CI: 96%-100%). CONCLUSION: Addition of CEDM for evaluation of low-moderate suspicion soft tissue breast lesions can substantially reduce biopsy of benign lesions without compromising cancer detection.
Authors: Andrea Cozzi; Simone Schiaffino; Marianna Fanizza; Veronica Magni; Laura Menicagli; Cristian Giuseppe Monaco; Adrienn Benedek; Diana Spinelli; Giovanni Di Leo; Giuseppe Di Giulio; Francesco Sardanelli Journal: Eur Radiol Date: 2022-06-01 Impact factor: 7.034
Authors: Kristen Coffey; Janice Sung; Christopher Comstock; Gulce Askin; Maxine S Jochelson; Elizabeth A Morris; Donna D'Alessio Journal: AJR Am J Roentgenol Date: 2020-10-07 Impact factor: 6.582
Authors: L M F H Neeter; H P J Raat; S D Meens-Koreman; R S A van Stiphout; S M E C Timmermans; K M Duvivier; M L Smidt; J E Wildberger; P J Nelemans; M B I Lobbes Journal: Sci Rep Date: 2021-11-15 Impact factor: 4.379