A descending enhancement pattern on CEM is associated with invasive breast cancer: the first Mexican experience

Introduction: There are few studies on the quantitative analysis and enhancement pattern of breast lesions on contrastenhanced mammography (CEM). We performed a quantitative analysis and defined CEM enhancement patterns of malignant, benign with upgrade potential (BWUP), and benign breast lesions with a histopathologic correlation. Materials and Methods: A retrospective cross-sectional study of women with breast lesions showing CEM enhancement patterns was conducted with a confirmed histopathologic diagnosis. The quantitative CEM parameters were the contrast-to-noise ratio (CNR), the percentage signal ratio between the enhanced lesion and background (%RS), and the relative signal difference (RSD). The enhancement patterns analyzed were ascending, steady, and descending. Results: A total of 32 women with a mean age of 53.5 ± 11.1 (range 33–75) years with 36 breast lesions assessed by CEM were included. Histopathologic diagnoses were infiltrating breast carcinoma (n = 13, 36.1%), breast carcinoma in situ (n = 2, 5.5%), BWUP (n = 4, 11.1%), and benign breast lesions (n = 17, 47.2%). The ascending pattern was found in 16 (44.4%) of the 36 lesions, the descending enhancement pattern in 15 (41.7%), and the steady pattern in 5 (13.9%). The descending enhancement pattern was significantly more frequent in infiltrating breast carcinomas (n = 9, 60.0%) (p = 0.018), while carcinoma in situ (n = 2) showed an ascending pattern (p = ns). Benign and BWUP lesions were more likely to show an ascending pattern (n = 9 and n = 3, respectively) (p = ns). Conclusion: This is the first study in Mexico to present a quantitative analysis and enhancement patterns to better characterize breast lesions in CEM. The descending enhancement pattern provides useful information for predicting invasive breast cancer.