{"id":{"repo_id":"milano","oai_identifier":"oai:air.unimi.it:2434/1056208"},"canonical_url":"https://search.dev.ndltd.org/etd/milano/oai:air.unimi.it:2434/1056208","repository":{"repo_id":"milano","name":"Università degli Studi di Milano","base_url":"https://air.unimi.it/oai/request"},"display":{"title":"CONTRAST-ENHANCED MAMMOGRAPHY: THE EMERGENT CONTRAST-ENHANCED BREAST IMAGING MODALITY","abstract":"Purpose: To evaluate if background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM), graded according to 2022 CEM-dedicated Breast Imaging Reporting and Data System (BI-RADS) lexicon, is associated with breast density, menstrual status, and age. Methods: This bi-centric retrospective analysis included CEM examinations performed for second-level assessment of suspicious mammographic findings. Three readers independently and blindly evaluated BPE on recombined CEM images and breast density on low-energy CEM images. Inter-reader reliability was estimated using Fleiss κ. Multivariable binary logistic regression was performed, dichotomising breast density and BPE as low (a/b BI-RADS categories, minimal/mild BPE) and high (c/d BI-RADS categories, moderate/marked BPE). Results: A total of 200 women (median age 56.8 years, interquartile range 50.5−65.6, 140/200 in menopause) were included. Breast density was classified as a in 27/200 patients (13.5%), as b in 110/200 (55.0%), as c in 52/200 (26.0%), and as d in 11/200 (5.5%), with moderate inter-reader reliability (κ=0.536; 95% confidence interval [CI] 0.482–0.590). BPE was minimal in 95/200 patients (47.5%), mild in 64/200 (32.0%), moderate in 25/200 (12.5%), marked in 16/200 (8.0%), with substantial inter-reader reliability (κ=0.634; 95% CI 0.581–0.686). At multivariable logistic regression, pre-menopausal status and breast density were significant positive predictors of high BPE, with adjusted odds ratios of 6.120 (95% CI 1.847–20.281, p=0.003) and 2.416 (95% CI 1.095–5.332, p=0.029) respectively. Conclusion: BPE on CEM is associated with well-established breast cancer risk factors, being higher in women with higher breast density and pre-menopausal status.","abstract_html":"Purpose: To evaluate if background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM), graded according to 2022 CEM-dedicated Breast Imaging Reporting and Data System (BI-RADS) lexicon, is associated with breast density, menstrual status, and age. Methods: This bi-centric retrospective analysis included CEM examinations performed for second-level assessment of suspicious mammographic findings. Three readers independently and blindly evaluated BPE on recombined CEM images and breast density on low-energy CEM images. Inter-reader reliability was estimated using Fleiss κ. Multivariable binary logistic regression was performed, dichotomising breast density and BPE as low (a/b BI-RADS categories, minimal/mild BPE) and high (c/d BI-RADS categories, moderate/marked BPE). Results: A total of 200 women (median age 56.8 years, interquartile range 50.5−65.6, 140/200 in menopause) were included. Breast density was classified as a in 27/200 patients (13.5%), as b in 110/200 (55.0%), as c in 52/200 (26.0%), and as d in 11/200 (5.5%), with moderate inter-reader reliability (κ=0.536; 95% confidence interval [CI] 0.482–0.590). BPE was minimal in 95/200 patients (47.5%), mild in 64/200 (32.0%), moderate in 25/200 (12.5%), marked in 16/200 (8.0%), with substantial inter-reader reliability (κ=0.634; 95% CI 0.581–0.686). At multivariable logistic regression, pre-menopausal status and breast density were significant positive predictors of high BPE, with adjusted odds ratios of 6.120 (95% CI 1.847–20.281, p=0.003) and 2.416 (95% CI 1.095–5.332, p=0.029) respectively. Conclusion: BPE on CEM is associated with well-established breast cancer risk factors, being higher in women with higher breast density and pre-menopausal status.","abstract_has_math":false,"creators":["MAGNI, VERONICA"],"institution":"Università degli Studi di Milano","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["tutor: F. Sardanelli ; phd coordinator: C. Sforza","V. Magni","SFORZA, CHIARELLA"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2024,"date_issued":"2024-06-04","date_published":"2024-06-04","updated_at":"2026-07-27T20:19:03Z","subjects":["Settore MED/36 - Diagnostica per Immagini e Radioterapia"],"languages":["eng"],"rights":["info:eu-repo/semantics/openAccess"],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["http://dx.doi.org/10.13130/magni-veronica_phd2024-06-04","10.13130/magni-veronica_phd2024-06-04"],"render_values":[{"text":"http://dx.doi.org/10.13130/magni-veronica_phd2024-06-04","href":"http://dx.doi.org/10.13130/magni-veronica_phd2024-06-04","code":true},{"text":"10.13130/magni-veronica_phd2024-06-04","href":"https://doi.org/10.13130/magni-veronica_phd2024-06-04","code":true}]}]},"links":{"outbound_url":"https://hdl.handle.net/2434/1056208","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["tutor: F. Sardanelli ; phd coordinator: C. Sforza","V. 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Methods: This bi-centric retrospective analysis included CEM examinations performed for second-level assessment of suspicious mammographic findings. Three readers independently and blindly evaluated BPE on recombined CEM images and breast density on low-energy CEM images. Inter-reader reliability was estimated using Fleiss κ. Multivariable binary logistic regression was performed, dichotomising breast density and BPE as low (a/b BI-RADS categories, minimal/mild BPE) and high (c/d BI-RADS categories, moderate/marked BPE). Results: A total of 200 women (median age 56.8 years, interquartile range 50.5−65.6, 140/200 in menopause) were included. Breast density was classified as a in 27/200 patients (13.5%), as b in 110/200 (55.0%), as c in 52/200 (26.0%), and as d in 11/200 (5.5%), with moderate inter-reader reliability (κ=0.536; 95% confidence interval [CI] 0.482–0.590). BPE was minimal in 95/200 patients (47.5%), mild in 64/200 (32.0%), moderate in 25/200 (12.5%), marked in 16/200 (8.0%), with substantial inter-reader reliability (κ=0.634; 95% CI 0.581–0.686). At multivariable logistic regression, pre-menopausal status and breast density were significant positive predictors of high BPE, with adjusted odds ratios of 6.120 (95% CI 1.847–20.281, p=0.003) and 2.416 (95% CI 1.095–5.332, p=0.029) respectively. Conclusion: BPE on CEM is associated with well-established breast cancer risk factors, being higher in women with higher breast density and pre-menopausal status.","Background: CEM is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. We therefore aimed to perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Methods: The Medline, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Using STATA, summary diagnostic odds ratio (DOR) and area under the curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results: Sixty studies (67 study parts, 11,049 CEM examinations from 10,605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled DOR was 55.7 (95% CI: 42.7, 72.7), with high heterogeneity (τ2 = 0.3). At meta-regression, CEM interpretation with both low-energy and recombined images had higher sensitivity (95% versus 94%, p < 0.001) and specificity (81% versus 71%, p = 0.03) compared to recombined images alone. At subgroup analysis, CEM showed a 95% pooled sensitivity (95% CI: 92, 97) and a 78% pooled specificity (95% CI: 66, 87) from nine studies on patients with dense breasts, while in 10 studies on mammography-detected suspicious findings CEM had a 92% pooled sensitivity (95% CI: 89, 94) and an 84% pooled specificity (95% CI: 73, 91). Conclusions: CEM demonstrated high performance for breast cancer detection, especially with joint interpretation of low-energy and recombined images.","Objectives: To evaluate the potential of a work-up strategy based on CEM for reducing the biopsy rate of screening recalls. Methods: Recalled women aged 40–80 were enrolled to undergo CEM alongside standard assessment (SA) through tomosynthesis, additional views, and/or ultrasound. Exclusion criteria were breast symptoms, breast implants, allergy to ICAs, renal failure, and pregnancy. One of six radiologists independently evaluated SA or CEM, recommending biopsy or two-year follow-up. Biopsy rates according to recombined CEM (rCEM) and according to SA were compared with the McNemar test. Diagnostic performance was calculated considering lesions with available definitive histopathology reports. Results: Between January 2019 and July 2021, 220 women were prospectively enrolled, 207 of them (median age 56.6 years) with 225 suspicious findings being analysed. Overall, 135/225 findings were referred for biopsy, 90/225 by both SA and rCEM, 41/225 by SA alone, 4/225 by rCEM alone. The 94/225 rCEM biopsy rate (41.8%, 95% CI 35.5–48.3%) was 16.4% lower (p < 0.001) than the 131/225 SA biopsy rate (58.2%, 95% CI 51.7–64.5%). Considering the 124/135 biopsies with definitive histopathology reports (44 benign and 80 malignant), rCEM showed a 93.8% sensitivity (95% CI 86.2–97.3%) and a 65.9% specificity (95% CI 51.1–78.1%), all 5 false negatives being ductal carcinoma in situ detectable as suspicious calcifications on low-energy CEM images. Conclusions: Compared to SA, the rCEM-based work-up would have avoided biopsy for 37/225 (16.4%) suspicious findings. The inclusion of low-energy images in exam interpretation may provide optimal overall CEM sensitivity."]},{"key":"dc:title","label":"Title","values":["CONTRAST-ENHANCED MAMMOGRAPHY: THE EMERGENT CONTRAST-ENHANCED BREAST IMAGING MODALITY"]}]}],"canonical_facts":{"dc:contributor":["tutor: F. Sardanelli ; phd coordinator: C. Sforza","V. Magni","SFORZA, CHIARELLA"],"dc:creator":["MAGNI, VERONICA"],"dc:date":["2024-06-04"],"dc:description":["Purpose: To evaluate if background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM), graded according to 2022 CEM-dedicated Breast Imaging Reporting and Data System (BI-RADS) lexicon, is associated with breast density, menstrual status, and age. Methods: This bi-centric retrospective analysis included CEM examinations performed for second-level assessment of suspicious mammographic findings. Three readers independently and blindly evaluated BPE on recombined CEM images and breast density on low-energy CEM images. Inter-reader reliability was estimated using Fleiss κ. Multivariable binary logistic regression was performed, dichotomising breast density and BPE as low (a/b BI-RADS categories, minimal/mild BPE) and high (c/d BI-RADS categories, moderate/marked BPE). Results: A total of 200 women (median age 56.8 years, interquartile range 50.5−65.6, 140/200 in menopause) were included. Breast density was classified as a in 27/200 patients (13.5%), as b in 110/200 (55.0%), as c in 52/200 (26.0%), and as d in 11/200 (5.5%), with moderate inter-reader reliability (κ=0.536; 95% confidence interval [CI] 0.482–0.590). BPE was minimal in 95/200 patients (47.5%), mild in 64/200 (32.0%), moderate in 25/200 (12.5%), marked in 16/200 (8.0%), with substantial inter-reader reliability (κ=0.634; 95% CI 0.581–0.686). At multivariable logistic regression, pre-menopausal status and breast density were significant positive predictors of high BPE, with adjusted odds ratios of 6.120 (95% CI 1.847–20.281, p=0.003) and 2.416 (95% CI 1.095–5.332, p=0.029) respectively. Conclusion: BPE on CEM is associated with well-established breast cancer risk factors, being higher in women with higher breast density and pre-menopausal status.","Background: CEM is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. We therefore aimed to perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Methods: The Medline, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Using STATA, summary diagnostic odds ratio (DOR) and area under the curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results: Sixty studies (67 study parts, 11,049 CEM examinations from 10,605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled DOR was 55.7 (95% CI: 42.7, 72.7), with high heterogeneity (τ2 = 0.3). At meta-regression, CEM interpretation with both low-energy and recombined images had higher sensitivity (95% versus 94%, p < 0.001) and specificity (81% versus 71%, p = 0.03) compared to recombined images alone. At subgroup analysis, CEM showed a 95% pooled sensitivity (95% CI: 92, 97) and a 78% pooled specificity (95% CI: 66, 87) from nine studies on patients with dense breasts, while in 10 studies on mammography-detected suspicious findings CEM had a 92% pooled sensitivity (95% CI: 89, 94) and an 84% pooled specificity (95% CI: 73, 91). Conclusions: CEM demonstrated high performance for breast cancer detection, especially with joint interpretation of low-energy and recombined images.","Objectives: To evaluate the potential of a work-up strategy based on CEM for reducing the biopsy rate of screening recalls. Methods: Recalled women aged 40–80 were enrolled to undergo CEM alongside standard assessment (SA) through tomosynthesis, additional views, and/or ultrasound. Exclusion criteria were breast symptoms, breast implants, allergy to ICAs, renal failure, and pregnancy. One of six radiologists independently evaluated SA or CEM, recommending biopsy or two-year follow-up. Biopsy rates according to recombined CEM (rCEM) and according to SA were compared with the McNemar test. Diagnostic performance was calculated considering lesions with available definitive histopathology reports. Results: Between January 2019 and July 2021, 220 women were prospectively enrolled, 207 of them (median age 56.6 years) with 225 suspicious findings being analysed. Overall, 135/225 findings were referred for biopsy, 90/225 by both SA and rCEM, 41/225 by SA alone, 4/225 by rCEM alone. The 94/225 rCEM biopsy rate (41.8%, 95% CI 35.5–48.3%) was 16.4% lower (p < 0.001) than the 131/225 SA biopsy rate (58.2%, 95% CI 51.7–64.5%). Considering the 124/135 biopsies with definitive histopathology reports (44 benign and 80 malignant), rCEM showed a 93.8% sensitivity (95% CI 86.2–97.3%) and a 65.9% specificity (95% CI 51.1–78.1%), all 5 false negatives being ductal carcinoma in situ detectable as suspicious calcifications on low-energy CEM images. Conclusions: Compared to SA, the rCEM-based work-up would have avoided biopsy for 37/225 (16.4%) suspicious findings. The inclusion of low-energy images in exam interpretation may provide optimal overall CEM sensitivity."],"dc:identifier":["https://hdl.handle.net/2434/1056208","http://dx.doi.org/10.13130/magni-veronica_phd2024-06-04","10.13130/magni-veronica_phd2024-06-04"],"dc:language":["eng"],"dc:publisher":["Università degli Studi di Milano"],"dc:relation":["numberofpages:123"],"dc:rights":["info:eu-repo/semantics/openAccess"],"dc:subject":["Settore MED/36 - Diagnostica per Immagini e Radioterapia"],"dc:title":["CONTRAST-ENHANCED MAMMOGRAPHY: THE EMERGENT CONTRAST-ENHANCED BREAST IMAGING MODALITY"],"dc:type":["info:eu-repo/semantics/doctoralThesis"]},"updated_at":"2026-07-27T20:19:03Z"}