Conspicuity of suspicious breast lesions on contrast enhanced breast CT compared to digital breast tomosynthesis and mammography

Objective: Compare conspicuity of suspicious breast lesions on contrast-enhanced dedicated breast CT (CEbCT), tomosynthesis (DBT) and digital mammography (DM). Methods: 100 females with BI-RADS 4/5 lesions underwent CEbCT and/or DBT prior to biopsy in this IRB approved, HIPAA compliant study. Two breast radiologists adjudicated lesion conspicuity scores (CS) for each modality independently. Data are shown as mean CS +/- standard deviation. Two-sided t-test was used to determine significance between two modalities within each subgroup. Multiple comparisons were controlled by the false-discovery rate set to 5%. Results: 50% of studied lesions were biopsy-confirmed malignancies. Malignant masses were more conspicuous on CEbCT than on DBT or DM (9.7 +/- 0.5, n = 25; 6.8 +/- 3.1, n = 15; 6.7 +/- 3.0, n = 27; p < 0.05). Malignant calcifications were equally conspicuous on all three modalities (CEbCT 8.7 +/- 0.8, n = 18; DBT 8.5 +/- 0.6, n = 15; DM 8.8 +/- 0.7, n = 23; p = NS). Benign masses were equally conspicuous on CEbCT (6.6 +/- 4.1, n = 22); DBT (6.4 +/- 3.8, n = 17); DM (5.9 +/- 3.6, n = 24; p = NS). Benign calcifications CS were similar between DBT (8.5 +/- 1.0, n = 17) and DM (8.8 +/- 0.8, n = 26; p = NS) but less conspicuous on CEbCT (4.0 +/- 2.9, n = 25, p < 0.001). 55 females were imaged with all modalities. Results paralleled the entire cohort. 69%(n = 62) of females imaged by CEbCT had dense breasts. Benign/malignant lesion CSs in dense/non-dense categories were 4.8 +/- 3.7, n = 33, vs 6.0 +/- 3.9, n = 14, p = 0.35; 9.2 +/- 0.9, n = 29 vs. 9.4 +/- 0.7, n = 14; p = 0.29, respectively. Conclusion: Malignant masses are more conspicuous on CEbCT than DM or DBT. Malignant microcalcifications are equally conspicuous on all three modalities. Benign calcifications remain better visualized by DM and DBT than with CEbCT. We observed no differences in benign masses on all modalities. CS of both benign and malignant lesions were independent of breast density. Advances in knowledge: CEbCT is a promising diagnostic imaging modality for suspicious breast lesions.