Interpretation of patterns of enhancement on contrast-enhanced spectral mammography: An approach to a standardized scheme

Objective: Applying the morphological descriptors described in the MRI breast imaging and reporting data system (BIRADS) in characterizing enhancing breast lesions seen on CESM. Methods: 178 breast lesions in patients with mean age 46 years in a prospective study were included. Morphological categorization of the included lesions was presented into focus, mass and non-mass forms. Furthermore classifications included (1) the margin, enhancement intensity for “focus” (2), the shape, margin and internal enhancement for “mass” and (3) the distribution and internal enhancement for “non-mass”. Each morphology descriptor was evaluated separately (irrespective of the other descriptors) by calculating its sensitivity, specificity, (PPV) and (NPV). Results: This study included 104 malignant lesions versus 74 benign. Diagnostic accuracy parameters for CESM were sensitivity 98% (102/104) and specificity 76% (56/74). Irregular margin intense enhancement focus (1/8) was diagnosed malignant, (7/8) while regular margin faint enhancing foci were benign.Irregular shape, spiculated margin and heterogeneous internal enhancement descriptors of mass lesion descriptors conformed to malignancy (PPV 92.5% of the former and 88.7% of the latter, p value ≤ 0.001).Asymmetry with segmental distribution, (17/27) (70.8%) heterogeneous and clumped internal enhancement patterns were indicative for malignancy in non mass enhancement (PPV