Mamografide Mikrokalsifikasyon Tespit Edilen Hastalarda Kontrastlı Spektral Mamografi ile Dinamik Meme MRG’nin Etkinliğinin Karşılaştırılması: Tek Merkez Deneyimi

Yıl 2021, Cilt: 5 Sayı: 3, 415 - 420, 25.12.2021

Kamber Göksu Ahmet Vural

https://doi.org/10.29058/mjwbs.960285

Öz

Amaç: Bu çalışmanın amacı, mammografi tetkiki ile mikrokalsifikasyon tespit edilen hastalarda kontrastlı
spektral mamografi (KSM) ile meme manyetik rezonans görüntülemenin (MRG) tanısal performansını
karşılaştırmaktır.
Gereç ve Yöntemler: Kasım 2014 - Mayıs 2019 tarihleri arasında mammografi ile mikrokalsifikasyon
saptanan, daha sonra hem KSM hem Meme MRG incelemesi yapılan 75 kadın (ort. Yaş, 56,3 yaş ±
10,6) çalışmaya dahil edildi. Hastaların çalışmaya dahil edilebilme kriteri olarak, histopatolojik olarak
tanı almış olması ve hem KSM hem Meme MRG tetkikinin yapılmış olması koşulu arandı. KSM ve
Meme MRG için patolojik kontrastlanma varlığı histopatolojik tanı ile birlikte Fisher-Freeman-Halton
Exact testi kullanılarak istatistiksel olarak karşılaştırıldı.
Bulgular: Mikrokalsifikasyon saptanmış 75 hastaya KSM ve Meme MRG incelemeleri yapıldı. Bu hastaların
Meme MRG incelemelerinde 47 olguda patolojik kontrast tutulumu tespit edildi. KSM incelemesi
ile 49 hastada mikrokalsifikasyon bölgesinde kontrast tutulumu mevcut idi. Her iki tetkik ile kontrast
tutulumu görülen 47 hasta ortak idi. Biyopsi sonucu benign gelenlerin kontrast tutulum oranları KSM ve
MRG için aynı idi (%48,9), malign olanların kontrast tutulum oranları KSM için %96 iken MRG için %88,
premalign olanların kontrast tutulumu KSM ve Meme MRG için %60 olarak bulundu. Biyopsi sonuçlarına
göre lezyonların kontrast tutulumları karşılaştırıldığında KSM ve Meme MRG için istatistiksel olarak
anlamlı bir farklılık saptanmadı.
Sonuç: KSM, daha az arka plan kontrastlanması göstermekte olup meme kanseri tespitinde Meme
MRG ile benzer duyarlılığa sahiptir. KSM, Meme MRG’ye göre daha kolay erişilebilir bir alternatif olup
işlem süresi anlamlı derecede daha kısadır. Bu nedenlerle meme kanseri tespiti ve evrelemesinde
önemli bir rol üstlenebilecek potansiyele sahiptir.

Anahtar Kelimeler

Mamografi, Mikrokalsifikasyon, Manyetik rezonans görüntüleme, Kontrastlı spektral mamografi

Comparison of the Effectiveness of Contrast-Enhanced Spectral Mammography and Dynamic Breast MRI in Patients with Microcalcifications Detected in Mammography: A Single Center Experience

Öz

Aim: The aim of this study is to compare the diagnostic performance of contrast-enhanced spectral
mammography (CESM) and breast magnetic resonance imaging (MRI) in patients with microcalcification
detected by mammography.
Material and Methods: A seventy-five women (mean age, 56.3 years ± 10.6 years) who were found to have microcalcification by
mammography between November 2014 and May 2019, and who had both CESM and Breast MRI examinations later were included in the
study. As the criteria for inclusion in the study, the condition that the patients were diagnosed histopathologically and that both CESM and
Breast MRI were performed were sought. The presence of pathological enhancement for CESM and Breast MRI was compared statistically
using the Fisher-Freeman-Halton Exact test together with histopathological diagnosis.
Results: CESM and Breast MRI examinations were performed in 75 patients with microcalcifications. Pathological contrast enhancement
was detected in 47 cases in breast MRI examinations of these patients. With CESM examination, 49 patients had contrast enhancement in
the microcalcification region. Forty-seven patients with contrast enhancement with both examinations were common. Contrast enhancement
rates of those who were found benign as a result of the biopsy were the same for CESM and MRI (48.9%). Contrast enhancement rates of
malignant ones were 96% for CESM, 88% for MRI, and 60% for CESM and Breast MRI for premalignant lesions. When contrast enhancement
of the lesions was compared according to the biopsy results, no statistically significant difference was found for CESM and Breast MRI.
Conclusion: CESM shows less background enhancement and has a similar sensitivity to breast MRI in detecting breast cancer. CESM is
an easily accessible alternative to Breast MRI and the procedure time is significantly shorter. For these reasons, it has the potential to play
an important role in breast cancer detection and staging.

Anahtar Kelimeler

Mammography, Microcalcification, Magnetic Resonance Imaging, Contrast-enhanced spectral mammography

Kaynakça

• 1. Loberg M, Lousdal ML, Bretthauer M, Kalager M. Benefitsand harms of mammography screening. Breast Cancer Res. 2015;17:63.
• 2. Shetty MK. Screening for breast cancer with mammogra-phy: current status and an overview. Indian J Surg Oncol. 2010;1:218-23.
• 3. Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breastcancer. N Engl J Med. 2007;356:227-36.
• 4. Mori M, Akashi-Tanaka S, Suzuki S, Daniels MI, WatanabeC, Hirose M, et al. Diagnostic accuracy of contrast-enhanced spectral mammography in comparison to con-ventional full-field digital mammography in a popula-tion of women with dense breasts. Breast Cancer 2016; 24:104–10.
• 5. Kolb TM, Lichy J, Newhouse JH. Comparison of the performanceof screening mammography, physical examination, and breastUS and evaluation of factors that influence them: an analysisof 27,825 patient evaluations. Radiology 2002;225:165-75.
• 6. Leach MO, Boggis CR, Dixon AK, Easton DF, Eeles RA, Evans DG,et al. Screening with magnetic resonance imaging and mam-mography of a UK population at high familial risk of breastcancer: a prospective multicentre cohort study (MARIBS). Lancet 2005;365:1769-78.
• 7. Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK,Acharyya S, et al. Diagnostic performance of digital versusfilm mammography for breast-cancer screening. N Engl J Med. 2005;353:1773-83.
• 8. Schell AM, Rosenkranz K, Lewis PJ. Role of breast MRI in the pre-operative evaluation of patients with newly diagnosed breastcancer. AJR Am J Roentgenol. 2009;192:1438-44.
• 9. Berg WA. Rationale for a trial of screening breast ultrasound: American College of Radiology Imaging Network (ACRIN) 6666. AJR Am J Roentgenol. 2003;180:1225-8.
• 10. Morris EA, Liberman L, Ballon DJ, Robson M, Abramson AF,Heerdt A, et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol. 2003;181:619-26.
• 11. Kim HR, Jung HK, Ko KH, Kim SJ, Lee KS. Mammography, US, and MRI for preoperative prediction of extensive intraductal component of invasive breast cancer: interobserver variability and performances. Clin Breast Cancer 2016;16:305-11.
• 12. Choi JS, Han BK, Ko EY, Ko ES, Hahn SY, Shin JH, et al. Comparison between two-dimensional synthetic mammography reconstructed from digital breast tomosynthesis and full-field digital mammography for the detection of T1 breast cancer. Eur Radiol. 2016;26:2538-46.
• 13. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, DixonJM, et al. Accuracy and surgical impact of magnetic reso-nance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248-58.
• 14. Li L, Roth R, Germaine P, Ren S, Lee M, Hunter K, Tinney E, Liao L. Contrast-enhanced spectral mammography (CESM) versus breast magnetic resonance imaging (MRI): A retrospective comparison in 66 breast lesions. Diagn Interv Imaging. 2017;98(2):113-123.
• 15. Nekhlyudov L, Kiarsis K, Elmore JG. MRI of the breast: does theinternet accurately report its beneficial uses and limitations? Breast J. 2009;15:189-93.
• 16. Dromain C, Balleyguier C, Muller S, Mathieu MC, Rochard F,Opolon P, et al. Evaluation of tumor angiogenesis of breast car-cinoma using contrast-enhanced digital mammography. AJR AmJ Roentgenol. 2006;187:W528-37.
• 17. Dromain C, Balleyguier C, Adler G, Garbay JR, DelalogeS. Contrast-enhanced digital mammography. Eur J Radiol. 2009;69:34-42.
• 18. Dromain C, Thibault F, Muller S, Rimareix F, Delaloge S, TardivonA, et al. Dual-energy contrast-enhanced digital mammography:initial clinical results. Eur Radiol. 2011;21:565-74.
• 19. Fallenberg EM, Dromain C, Diekmann F, Engelken F, Krohn M,Singh JM, et al. Contrast-enhanced spectral mammography ver-sus MRI: initial results in the detection of breast cancer andassessment of tumour size. Eur Radiol. 2014;24:256-64.
• 20. Lewin JM, Isaacs PK, Vance V, Larke FJ. Dual-energycontrast-enhanced digital subtraction mammography: feasibil-ity. Radiology 2003;229:261-8.
• 21. Jochelson MS, Dershaw DD, Sung JS, Heerdt AS, Thornton C,Moskowitz CS, et al. Bilateral contrast-enhanced dual-energydigital mammography: feasibility and comparison with conven-tional digital mammography and MR imaging in women withknown breast carcinoma. Radiology 2013;266:743-51.
• 22. Badr S, Laurent N, Regis C, Boulanger L, Lemaille S, Pon-celet E. Dual-energy contrast-enhanced digital mammographyin routine clinical practice in 2013. Diagn Interv Imaging 2014;95:245-58.
• 23. Patel BK, Lobbes MBI, Lewin J. Contrast enhanced spectral mammography: a review. Semin Ultrasound CT MR. 2018;39:70.
• 24. Mohamed Kamal R, Hussien Helal M, Wessam R, Mahmoud Mansour S, Godda I, Alieldin N. Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions. Eur J Radiol. 2015;84:1049-1055.
• 25. Cheung YC, Tsai HP, Lo YF, Ueng SH, Huang PC, Chen SC. Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis. Eur Radiol. 2016;26:1082-1089.
• 26. Cheung YC, Juan YH, Lin YC. Dual-energy contrast-enhanced spectral mammography: enhancement analysis on BI-RADS 4 non-mass microcalcifications in screened women. PLoS One. 2016;11:e0162740.