BIRADS 4 - Is it possible to downgrade lesions that do not enhance on recombinant contrast-enhanced mammography images?

• Published in: European journal of radiology Vol. 167; p. 111062
• Main Authors: Grażyńska, Anna, Niewiadomska, Agnieszka, Owczarek, Aleksander J, Winder, Mateusz, Hołda, Jakub, Zwolińska, Olga, Barczyk-Gutkowska, Anna, Lorek, Andrzej, Kuźbińska, Aleksandra, Steinhof-Radwańska, Katarzyna
• Format: Journal Article
• Language: English
• Published: Ireland 01.10.2023
• Subjects: Breast Neoplasms - diagnostic imaging; Calcinosis - diagnostic imaging; Female; Humans; Mammography; Physical Examination; Retrospective Studies; Breast cancer; Contrast enhanced mammography; Breast biopsy
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2023.111062

Analysis of the morphology of lesions classified into the BI-RADS 4 category and assessment of the possibility of downgrade the BI-RADS category in those that did not show enhancement on recombinant contrast-enhanced mammography (CEM) images. The retrospective, single-center study included 528 patients who underwent a core needle biopsy performed from January 2017 to November 2022 due to a breast lesion classified as BI-RADS 4 on CEM. Patients' electronic records and imaging examinations were reviewed. Individual lesions were classified into the morphological categories of mass, non-mass, and microcalcifications. Sensitivity, specificity, positive as well as negative predictive values were calculated for the whole group and individual morphological categories. The influence of the lesions' diameter on the results was analyzed. CEM NPV for the whole group was 93.9% (±95% CI: 90.0-96.4), for mass lesions 100% (±95% CI: 94.5-100), for non-mass lesions 97.8% (±95% CI: 87.0-99.9) and 87.9% (±95% CI: 80.3-93.0) for microcalcifications. Given that 230 out of 383 benign lesions were not contrast-enhancing, 60.1% of unnecessary CNBs would have been correctly avoided. CEM sensitivity for lesions < 20 mm was lower than for lesions ≥ 20 mm and was respectively 86.6% (±95% CI: 76.8-92.8) vs 94.6% (±95% CI: 86.0-98.2), respectively. CEM is characterized by high sensitivity in the detection of malignant lesions in the case of lesions with mass and non-mass morphology. The high NPV for recombinant images suggests that in the case of these lesions, the lack of enhancement supports the benign nature of the lesion and may lead to a downgrade of the BI-RADS category.