J Cancer 2015; 6(2):144-150. doi:10.7150/jca.10705

Research Paper

The Quality of Tumor Size Assessment by Contrast-Enhanced Spectral Mammography and the Benefit of Additional Breast MRI

Marc B.I. Lobbes1,5, Ulrich C. Lalji1, Patty J. Nelemans2, Ivo Houben1, Marjolein L. Smidt3,5, Esther Heuts3, Bart de Vries4, Joachim E. Wildberger1,5, Regina G. Beets-Tan1,5✉

1. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center,
2. Department of Epidemiology, Maastricht, the Netherlands, Maastricht, the Netherlands; Maastricht University;
3. Department of Surgical Oncology, Maastricht University Medical Center;
4. Department of Pathology, Maastricht University Medical Center;
5. GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.

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Lobbes MBI, Lalji UC, Nelemans PJ, Houben I, Smidt ML, Heuts E, de Vries B, Wildberger JE, Beets-Tan RG. The Quality of Tumor Size Assessment by Contrast-Enhanced Spectral Mammography and the Benefit of Additional Breast MRI. J Cancer 2015; 6(2):144-150. doi:10.7150/jca.10705. Available from http://www.jcancer.org/v06p0144.htm

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Background - Contrast-enhanced spectral mammography (CESM) is a promising new breast imaging modality that is superior to conventional mammography for breast cancer detection. We aimed to evaluate correlation and agreement of tumor size measurements using CESM. As additional analysis, we evaluated whether measurements using an additional breast MRI exam would yield more accurate results.

Methods - Between January 1st 2013 and April 1st 2014, 87 consecutive breast cancer cases that underwent CESM were collected and data on maximum tumor size measurements were gathered. In 57 cases, tumor size measurements were also available for breast MRI. Histopathological results of the surgical specimen served as gold standard in all cases.

Results - The Pearson's correlation coefficients (PCC) of CESM versus histopathology and breast MRI versus histopathology were all >0.9, p<0.0001. For the agreement between measurements, the mean difference between CESM and histopathology was 0.03 mm. The mean difference between breast MRI and histopathology was 2.12 mm. Using a 2x2 contingency table to assess the frequency distribution of a relevant size discrepancy of >1 cm between the two imaging modalities and histopathological results, we did not observe any advantage of performing an additional breast MRI after CESM in any of the cases.

Conclusion - Quality of tumor size measurement using CESM is good and matches the quality of these measurement assessed by breast MRI. Additional measurements using breast MRI did not improve the quality of tumor size measurements.

Keywords: breast cancer, mammography, CESM, CEDM, MRI.