Clinical utility of contrast-enhanced spectral mammography with histopathological correlation

Objectives To determine the diagnostic accuracy of CEM in differentiating benign from malignant breast lesions. Materials and Methods A retrospective study was conducted for 26 months, and 58 patients who underwent CESM and biopsy with histopathologically proven breast lesions were selected for the study. Modalities used for image acquisition included ultrasound, mammography, and CESM. Image analysis was done, BI-RADS was assigned to all cases and correlation with the final histopathological diagnosis was observed. The chi-square test or Fischer exact test was performed, and analysis was done using IBM SPSS Statistics software. Results A statistically significant association was observed with high predictive values when correlating CESM findings with histopathology. CESM demonstrated a sensitivity of 86.9%, specificity of 74.3%, positive predictive value of 68.9%, negative predictive value of 89.6%, and an overall diagnostic accuracy of 79.3%. Most malignant lesions (73.9%) showed heterogeneous enhancement, while the majority of benign lesions (68.6%) exhibited homogeneous enhancement. These findings highlight CESM’s effectiveness in differentiating benign from malignant breast lesions. Conclusion This study demonstrated the effectiveness of CESM in distinguishing benign from malignant breast lesions and complementing conventional imaging. CESM showed a strong correlation with histopathology, especially useful in dense breast tissue. However, despite these advantages, CESM has certain limitations, including the possibility of false positives or negatives and exposure to ionizing radiation, highlighting the need for careful, patient-specific application.