@article{3101395,
    title = "Adding the power of iodinated contrast media to the credibility of mammography in breast cancer diagnosis",
    author = "Tsigginou, A. and Gkali, C. and Chalazonitis, A. and Feida, E. and Vlachos, D.E. and Zagouri, F. and Rellias, I. and Dimitrakakis, C.",
    journal = "The British Journal of Radiology",
    year = "2016",
    volume = "89",
    number = "1067",
    publisher = "British Institute of Radiology",
    issn = "0007-1285, 1748-880X",
    doi = "10.1259/bjr.20160397",
    keywords = "iodinated contrast medium;  molybdenum;  rhodium;  contrast medium;  iohexol;  iopromide, adult;  aged;  area under the curve;  breast abscess;  breast cancer;  breast carcinoma;  breast cyst;  breast fibroadenoma;  breast hamartoma;  breast imaging reporting and data system classification score;  breast papilloma;  cancer classification;  clinical decision making;  contrast enhancement;  controlled study;  diagnostic accuracy;  diagnostic test accuracy study;  digital mammography;  dual energy contrast enhanced spectral mammography;  early cancer diagnosis;  female;  histopathology;  human;  intraductal carcinoma;  lymphadenopathy;  major clinical study;  malignancy potential score;  mammography;  mammography system;  Paget nipple disease;  Review;  standard;  very elderly;  analogs and derivatives;  biopsy;  breast tumor;  computer assisted diagnosis;  diagnostic imaging;  differential diagnosis;  early cancer diagnosis;  mammography;  middle aged;  pathology;  procedures;  prospective study;  sensitivity and specificity, Adult;  Aged;  Aged, 80 and over;  Biopsy;  Breast Neoplasms;  Contrast Media;  Diagnosis, Differential;  Early Detection of Cancer;  Female;  Humans;  Iohexol;  Mammography;  Middle Aged;  Prospective Studies;  Radiographic Image Interpretation, Computer-Assisted;  Sensitivity and Specificity",
    abstract = "Dual-energy contrast-enhanced spectral mammography (CESM) represents a relatively new diagnostic tool adjunct to mammography. The aim of this study was to strengthen the breast imaging-reporting and data system (BIRADS) classification score in order to improve early breast cancer diagnosis. For this reason, we propose a sum score, termed malignancy potential score (MPS), incorporating the standard BIRADS score and our proposed CESM score. From September 2014 to September 2015, 216 females (age range, 26-85 years; mean age 54.6 years) underwent CESM evaluation of mammographic findings that were primarily assessed as BIRADS 2-5. 10 of these patients had bilateral findings; a total of 226 lesions were examined. High-energy image evaluation was based on the intensity of contrast enhancement of the lesion compared with background enhancement, categorized as Type-1, 0, 1 or 2 enhancement. Histopathology reports were compared with imaging assessment. 98 of 226 lesions were malignant and 128 of 226 lesions were benign. The area under the curve was 0.843, 0.888 and 0.917 for mammographic BIRADS score, CESM score and MPS, respectively, with p-value , 0.05. The sensitivity, specificity and accuracy rates were 91.83, 80.47 and 85.40%, respectively, when a best MPS cut-off point of 4 was used. The malignancy potential score (MPS) has higher diagnostic performance than digital mammography or CESM alone. MPS empowers the credibility of the digital mammography BIRADS score and our proposed type of enhancement in dual-energy CESM and is a diagnostic tool that increases the accuracy rate in early breast cancer diagnosis."
}