Contrast-enhanced spectral mammography: CESM descriptive analysis with pathologic correlation

Transcription

1 Contrast-enhanced spectral mammography: CESM descriptive analysis with pathologic correlation Poster No.: C-0930 Congress: ECR 2015 Type: Scientific Exhibit Authors: F. RUBIO, P. Escobar, C. Jurado; Sevilla/ES Keywords: Breast, Mammography, Contrast agent-intravenous, Cancer DOI: /ecr2015/C-0930 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 22

2 Aims and objectives To establish a correlation between the pattern of enhancement with CESM and histologic findings. Methods and materials From January 2013 to december 2014 we performed CESM to 287 women, 24 to 82 years old. Previously, ethical approve was got from the specific committee as well as informed patient consent obtained. 206 (72 %) had clinical findings or suspicious screening mammography; 55 (19 %) had non conclusive clinical or imaging findings; in 11 (4 %) differential diagnosis was between scar and relapse; 13 (4 %) had dense breast with high genetic risk Table 1 on page 15. CESM images were reviewed by using reading criteria based on contrast enhancement intensity and morphology similar to those described in the Breast Imaging, Reporting and Data System (BI-RADS) MRI lexicon developed by the American College of Radiology. We have found four descriptors: FOCUS Fig. 1 on page 3 Enhancement point < 5 mm, wich morphology and margins can't be described in any other way. MASSES Fig. 2 on page 5 Fig. 3 on page 7 Enhancement of an area # 5 mm, usually unique. NON-MASS Fig. 4 on page 9 Enhancement of an area, without a clearly defined nodule. The enhanced area could be small or large, it can be described differently from normal breast pattern enhancement. RING ENHANCEMENT Fig. 5 on page 11 Mass enhancement with a more intense periphery and with a high PPV for cancer. In this study we have not evaluated the modifiers of the usual descriptors, however RING ENHANCEMENT has been identified as a specific enhancement. Page 2 of 22

3 We also describe a "GLANDULAR EHNHACEMENT" Fig. 6 on page 13: Background parenquimal enhancement -BPE- without pathological significance, associated with the breast radiological density and possibly with the menstrual cicle of women. We don't consider the glandular enhancement as a specific descriptor, however it must be taken into account since it may modify the sensitivity. The intensity of MASS enhancement was: INTENSE Fig. 2 on page 5 MODERATE Fig. 3 on page 7 and FAINT. After analyzing the findings they are classified according BI-RADS classification (I to VI) Images for this section: Page 3 of 22

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5 Fig. 1: FOCUS: Enhance <5 mm, middle intensity enhancement, poorly defined margins : IDC Page 5 of 22

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7 Fig. 2: MASS Irregularly shaped, spiculated margins, intense and homogeneous internal enhancement: IDC Page 7 of 22

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9 Fig. 3: MASS MODERATE intensity: Moderately well-defined homogeneous enhancement: IDC Page 9 of 22

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11 Fig. 4: NON MASS enhancement. Segmental, heterogeneous and asymmetric distribution Page 11 of 22

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13 Fig. 5: RING enhancement: IDC Page 13 of 22

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15 Fig. 6: GLANDULAR ENHANCEMENT: No nodular enhancement, moderate intensity, symmetrical and widespread distribution in both breasts, indicating a physiological parenchymal enhancement. It is related to the radiological density and the menstrual cycle. Table 1: We performed CESM to women with clinical findings or suspicious screening mammography; non conclusive clinical or imaging findings; Differential diagnosis between scar and relapse; dense breast with genetic risk; Unknown Primary or women in neoadjuvant treatment for breast cancer Page 15 of 22

16 Results 365 lesions were analyzed, 308 (84,38 %) showed some type of enhancement, 252 (81,82 %) were considered suspicious. 1 IDC and 1 DCIS (3,50 %) were found in 57 lesions that do not enhance. Sensitivity 95,05 %; specificity 82,81 %; PPV 91,27 % and NPV 93,85 % were calculated. We perform a detailed assessment according to type and intensity enhancement thereof as shown in the attached tables study. Mass enhancements are normally correlated with malignancy. Table 2 on page 16. Intense, no-mass enhancement shows malignancy in 92,85 %; this type of enhancement is often related to DCIS associated with an invasive component Table 3 on page 17. Focus enhancements are often associated with malignant lesions, mainly as a second or third multifocal carcinoma Table 4 on page 18. Following the criteria BI-RADS RM we have classified the lesions in categories I to VI; the porcenajes of malignant and benign tumors, as shown in the graphs, are consistent with categories, except for BIRADS III, which has a high percentage of malignancy, possibly because many of them should have been classified as IV. BI-RADS III for CESM is not well defined. Table 5 on page 18 We describe the findings in detail according to its type and intensity, and correlate them to its histological finding after core biopsy. No other descriptors have been evaluated in this study such as shape or contours in mass enhancements, neither distribution nor morphology in non-mass enhancements Findings that did not enhance and had neither clinical nor imaging suspicious were considered benign; they have been scheduled for follow-up Images for this section: Page 16 of 22

17 Table 2: Mass enhancements are normally correlated with malignancy. High intensity enhancements, and ring enhancement are often correlated with malignancy. Moderate and weak enhancements may be related to both benign and malignant. Findings of CESM are assessed together with clinical data and other imaging studies. Page 17 of 22

18 Table 3: No mass enhancement is also associated to malignancy for a high percentage of cases, however, when the intensity is low, sometimes it is difficult to make the differential diagnosis with a normal glandular enhancement. Table 4: Focus enhancements indicate malignancy in a similar percentage as mass enhancements do. Page 18 of 22

19 Table 5: The BI-RADS category III needs to establish good descriptors, many of the lesions resulting in malignancy were classified as IV in mammography or MRI. Page 19 of 22

20 Conclusion CESM is an emerging and useful tool, less expensive than MRI. We propose an approach with BI-RADS CESM.Its seem feasible to report CESM findings with BI-RADS MRI patterns, but broader studies, including malignant but also benign lesions are necessary Personal information FAUSTO RUBIO, Radiologist. Breast Imaging Diagnostic Section. Radiology Departmen Valme hospital. Manager Breast Imaging Diagnostic and Institutional Breast Screening Program. Health Area south of Seville, Andalusia, Spain. PILAR ESCOBAR, Radiologist. Breast Imaging Diagnostic Section. MRI Diagnostic Section. Radiology Departmen Valme hospital. Health Area south of Seville, Andalusia, Spain. CARMEN JURADO, Radiologist. MRI Diagnostic Section. Radiology Departmen Valme hospital. Health Area south of Seville, Andalusia, Spain. Page 20 of 22

21 References Breast Cancer. American Cancer Society BreastCancer/DetailedGuide/breast-cancer-key-statistics. Jochelson MS, Dershaw DD, Sung JS, et al. Bilateral Contrast-enhanced Dual-energy Digital Mammography: Feasibility and Comparison with Conventional Digital Mammography and MR Imaging in Women with Known Breast Carcinoma. Radiology 2013;266(3): Boyd FM, Guo H, Martin LJ, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356: Van Ongeval C, Van Steen A, Vande Putte G, et al. Does Digital Mammography in a Decentralized Breast Cáncer Screening Program Lead to Screening Performance Parameters Comparable with Film-Screen Mammography? Eur Radiol 2010;20(10): Morris EA, Liberman L, Ballon DJ, et al. MRI of Accult Breast Carcinoma in a High-risk Population. AJR Am J Roentgenol 2003;181(3): Houssami N, Ciatto S, Macaskill P, et al. Accuracy and Surgical Impact of Magnetic Resonance Imaging in Breast Cancer Staging: Systematic Review and Meta-analysis in Detection of Multifocal and Multicentric Cáncer. J Clin Oncol 2008;26(19): Dromain C Thibault F, Muller S, et al. Dual-energy Contrast-enhanced Digital Mammography: Initial Clinical Results. Eur Radioil 2011;21(3): Jochelson M, et al Can the Low Energy Mammogram Done Durinf Contrastenhanced Digital Mammography Replace Standard mammography? RSNA 2013 LL-BRS-TU4A. Watanabe M, Mizutani M Mori M, et al. Dose Evaluation in Clinical Studi of Contrasts -enhaced Spectral Mammography (CESM) for Japanese Women ECR 2013 poster C-1917 Jong RA,Yaffe MJ, Skarpathiotakis M, et al. Contrast-enhanced Digital Mammography: Inital Clinical Experience. Radiology 2003; 228: Lawaczeck R, Diekmann F, Diekmann S, et al. New Contrast Media Designed for X.Ray Eneregy Substraction Imaging in Digital Mammography. Investigative Radiology 2003;38 (9): Lewin JM, Isaacs PK, Vance V, et al. Dual-energy Contrast-enhanced Digital Substraction Mamografy: Feasibility. Radiology 2003; 229: Knogler T, Leithner R, Hörning M, et al. Clinical Feasibility of Contrastenhanced Dual-energy mammography (CEDEM) whith a Tungsten (W)/ Titanium(Ti) Anode/Filter Combination: A Prototipe Report. ECR 2013 B Page 21 of 22

22 14. Carton AK, Gavenonis SC, Currivan JE, et al. Dual-energy Contrast-enhanced Digital Breast Tomosynthesis - a Feasibility Study. Br J Radiol April; 83(988): Chalazonitis AN, Feidas e Liopiris Set al. Contrast Enhanced Digital Mammography. Spectrum of Imaging Findings. Radiological Society of North 2013 America Scientific Assembly and Annual Meeting, december 1- decembre 6, Chicago Ill. Rsna2013.rsna.org/program/details/? emid= Accessed february 28, Rodriguez E, et al. Contrast Enhanced Spectral mammography: Initial Experience with Benign and Malignant Lesions. A Pictorial Review with Mammographic, MRI, Ultrasound and Patologic Correlation. RSNA 2013 educational exhibit LL-BRE2460. Radiological Society of North 2013 America Scientific Assembly and Annual Meeting, december 1- decembre 6, Chicago Ill. 17. Knogler T, Leithner M, Hörning M, et al. Compararison of Contrast-enhanced dual-energy Mammography (CEDEM) with Contrast-enhanced Magnetic Resonance Imaging (CE-MRI) in Breast Lesions: A Prototype Report. ECR 2013 Oral presentation B Dromain C, Balleyguier C, Muller S, et al. Evaluation of Tumor Angiogénesis of Breast Carcinoma Using Contrast Enhanced Digital Mammography. Am J Roentgenol 2006, 187: Helal MH, Fouad MA, Wessam I, et al The Impact of Contrast-enhanced Digital Mammography on the Characterization of Breast Lesions. ECR 2013 Oral presentation B march 20. Fallenberg EM, Dromain C, Diekmann F, et al. Contrast-enhanced Spectral Mammography versus MRI: Initial Results in the Detection of Breast Cancer and Assessment of Tumour Size. European Radiology 2014; 24 (1): Fallenberg EM et al. Contrast-enhanced Spectarl Mammography vs. Mammography and MRI - Clinical Performance in a Multireader Evaluation. RSNA 2013 Oral presentation VSBR Radiological Society of North 2013 America Scientific Assembly and Annual Meeting, december 1decembre 6, Chicago Ill. 22. Jochelson MS, et al. Bening Enhancement on Contrast Enhanced Dual Energy Digital Mammography RSNA 2013 Oral presentation VSBR Radiological Society of North 2013 America Scientific Assembly and Annual Meeting, december 1- decembre 6, Chicago Ill. 23. American College of Radiology: Breast Imaging Reporting and Data System: BI-RADS. 4 edition. Reston, VA: American College of Radiology; Page 22 of 22