Architecture distortion score (ADS) in malignancy risk stratification of architecture distortion on contrast-enhanced digital mammography

• DOI: 10.1007/s00330-020-07395-3
• Publication Date: 2020-10-30T06:02:41Z
• Authors: Yonggeng Goh; Ching Wan Chan; Premilla Pillay; Herng-Sheng Lee; Huay-Ben Pan; Bao-Hui Hung; Swee Tian Quek; Chen-Pin Chou
• Keywords: 610; Breast Neoplasms; Architecture distortion; Middle Aged; Risk Assessment; Sensitivity and Specificity; Radiographic Image Enhancement; 03 medical and health sciences; 0302 clinical medicine; 617; Humans; Female; Breast; Contrast-enhanced digital mammography; Early Detection of Cancer; Mammography; Retrospective Studies

Abstract Objective To develop a risk predictor model in evaluation of tomosynthesis-detected architectural distortion (AD) based on characteristics of contrast-enhanced digital mammography (CEDM).

Methods Ninety-four AD lesions on CEDM in combination with tomosynthesis were retrospectively reviewed from 92 consecutive women (mean age, 52.4 years ± 7.9) with abnormal diagnostic or screening mammography. CEDM results were correlated with histology of ADs using cross-tabulation for statistical analysis. Predictors for risk of malignancy from CEDM characteristics (background parenchyma enhancement, degree of AD enhancement, enhancing morphology, size of enhancement, and enhancing spiculations) and patient’s age were evaluated using logistic regression. We propose a sum score, termed AD score (ADS), for risk stratification and corresponding suggested BI-RADS category.

Results Thirty-three of ninety-four (35.1%) of detected AD lesions were malignant. The sensitivity, specificity, PPV, and NPV of CEDM in evaluation of malignant AD are 100%, 42.6%, 48.5%, and 100%, respectively. Absence of AD enhancement on CEDM is highly indicative of no underlying malignancy. On multivariate analysis, the predictors on CEDM with statistical significance are (1) marked intensity of AD enhancement (OR, 22.6; 95%CI 3.1, 166.6; p = .002); and (2) presence of enhancing spiculations (OR, 9.1; 95%CI 2.2, 36.5; p = .002). A prediction model whose scores (ADS) given by ranking of OR of all predictors with AUC of 0.934 and Brier score of 0.0956 was developed.

Conclusion ADS-based lesion characterization on CEDM enables risk assessment of tomosynthesis-detected AD lesions.

Key Points • Architecture distortions presenting with marked enhancement intensity and presence of enhancing spiculations are highly associated with risk of malignancy. • Absence of architecture distortion enhancement in minimal or mild background parenchyma enhancement on CEDM indicates low risk of breast malignancy (NPV = 100%).