الفهرس 
ANATOMY OF THE BREASTOnly 14 pages are availabe for public view
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Abstract
C
ontrast enhanced digital mammography (CEDM) is an advanced technique to detect the tumor neoangiogenesis by using two techniques either the temporal subtraction technique with acquisition of high-energy images before and after contrast medium injection or the dual energy technique with acquisition of a pair of low and high-energy images only after contrast medium injection.
The potential clinical applications are the clarification of mammographically equivocal lesions, the detection of occult lesions on standard mammography, particularly in dense breast, the determination of the extent of disease, the assessment of recurrent disease and the monitoring of the response to chemotherapy
The purpose of this study was to evaluate the capability of CESM to upgrade/downgrade BIRADS category of equivocal and suspicious breast lesions, to assess the diagnostic performance of CESM in comparison to the conventional imaging and to suggest the most reliable morphology descriptors and enhancement criteria to differentiate benign and malignant lesions.
30 female patients with 44 equivocal and suspicious breast lesions, were enrolled in our study, age ranged from 20 to 76 years. All patients underwent conventional mammography and ultrasound then CESM.
Disagreement about BIRADS category was observed in 25% of the examined lesions including upgraded and down graded lesions in 11.36 % and 13.6 % respectively. 100% of up/down graded lesions also proved CESM to be correct in reference to the final diagnosis.
In this study; CESM achieved sensitivity 100%, specificity 42.9%, NPV 100% and PPV 65.7 %.
CESM proved to be reliable in detection of multifocal/multicenteric disease in our study as well; all cases were detected by CESM 6/6 (100%), 5/6 (83.3%) by US and 3/6 (50%) by FFDM.
Enhancing lesions were classified into enhancing mass lesions and non mass enhancing lesions. Enhancing mass lesions were characterized according to their shape, margins, pattern of enhancement and intensity of enhancement.
We assessed the most significant morphology descriptors and enhancement criteria among the malignant enhancing mass lesions in our study. The mass margin (spiculated and irregular) appears to be the most reliable descriptor to suggest malignancy. Followed by pattern of enhancement (heterogenous internal enhancement), then the shape of mass lesions (irregular) and degree of enhancement (intense enhancement).
The most specific descriptors in our study were the spiculated margin (100% malignant and none was benign, i.e. specificity=100% and PPV= 100%), and intense enhancement (100% malignant and none was benign, i.e. specificity=100% and PPV= 100%). Followed by irregular shape (sp.= 88.9% and PPV: 93.8%), then heterogenous enhancement (sp.= 66.7%, PPV: 85.7%) and irregular margins (sp.: 66.7%, PPV:82.4%).
Regarding the descriptors of benign mass lesions among our patients, round/oval shape also correlated with benignity (88.8% of benign lesions). We also observed that 66.6 5 of benign mass lesions displayed circumscribed margin and 100% of smooth (circumscribed) margin masses were benign.
7/44 NME lesioins were reported in our study and were assessed according to their distribution (focal – segmental – regional), pattern of enhancement (homogenous-heterogenous), and degree of enhancement (mild-moderate-intense). The limited number of NME lesions lead to inadequate representation of the NME descriptors in our study, all of which were statistically insignificant.