Diagnostic performance of contrast-enhanced spectral mammography in the evaluation of suspicious microcalcifications without associated mass

Background Contrast-enhancing magnetic resonance imaging is an expensive examination compared to contrast-enhanced spectral mammography (CESM) and cannot show microcalcifications. Purpose To investigate the diagnostic performance of CESM for malignancy with microcalcifications alone and the relationship between tumor immunohistochemistry findings and tumor grade. Material and Methods A total of 117 patients with suspected microcalcification at CESM were applied to our hospital between January 2022 and May 2024. Patients with accompanying mass and architectural distortion (n = 9) and the ones lacking pathology results (n = 11) were excluded. Patients with CESM and histopathological diagnosis (n = 97) were evaluated retrospectively. Mammography images were analyzed according to the American College of Radiology Breast Imaging-Reporting and Data System lexicon. Results In our study, the diagnostic value of the presence of contrast enhancement in CESM was high in the evaluation of suspicious breast microcalcifications. Malignant pathology was detected in all of the microcalcifications with high-risk morphology. In addition, all of the microcalcifications that enhanced in solid and ground-glass form were invasive ductal carcinoma. However, no significant relationship was found between immunohistochemical parameters (ER, PR, CerB2, Ki-67 and grade) and enhancement in CESM. The highest enhancement rate among malignant subtypes was detected in the luminal B group. Conclusion CESM is useful to reduce the number of unnecessary benign biopsies with suspicious microcalcifications in the breast, and provides an important contribution to the radiologist's biopsy decision by simultaneously showing the morphological features of the microcalcification and the contrast enhancement information.