Background:Contrast-enhanced mammography (CEM) has recently gained recognition as an effective alternative to breast magnetic resonance imaging (MRI) for assessing breast lesions, offering both morphological and functional imaging capabilities. However, the phenomenon of background parenchymal enhancement (BPE) remains a critical consideration, as it can affect the interpretation of images by obscuring or mimicking lesions. While the impact of BPE has been well-documented in MRI, limited data are available regarding the factors influencing BPE in CEM and its relationship with breast cancer (BC) characteristics.Materials:This retrospective study included 116 patients with confirmed invasive BC who underwent CEM prior to biopsy and surgery. Data collected included patient age, breast density, receptor status, tumor grading, and the Ki-67 proliferation index. BPE was evaluated by two radiologists using the 2022 ACR BI-RADS lexicon for CEM. Statistical analyses were conducted to assess the relationship between BPE, patient demographics, and tumor characteristics.Results:The study found a significant association between higher levels of BPE and specific patient characteristics. In particular, increased BPE was more commonly observed in patients with higher breast density (p< 0.001) and those who were pre-menopausal (p= 0.029). Among patients categorized under density level B, the majority exhibited minimal BPE, while those in categories C and D showed progressively higher levels of BPE, indicating a clear trend correlating higher breast density with increased enhancement. Additionally, pre-menopausal patients demonstrated a higher likelihood of moderate to marked BPE compared to post-menopausal patients. Despite these significant associations, the analysis did not reveal a meaningful correlation between BPE intensity and tumor subtypes (p= 0.77) or tumor grade (p= 0.73). The inter-reader agreement for BPE assessment was substantial, as indicated by a weighted kappa of 0.78 (95% CI: 0.68–0.89), demonstrating consistent evaluation between radiologists.Conclusions:These findings suggest that BPE in CEM is influenced by factors like breast density and age, aligning with patterns observed in MRI studies. However, BPE intensity was not associated with tumor subtypes or grades, indicating a poorer prognosis. These insights highlight the potential of BPE as a risk biomarker in preventive follow-up, particularly for patients with high breast density and pre-menopausal status. Further multicentric and prospective studies are needed to validate these results and deepen the understanding of BPE’s role in CEM diagnostics.
背景：对比增强乳腺X线摄影（CEM）作为一种评估乳腺病变的有效替代手段，近年来逐渐获得认可，其兼具形态学与功能成像能力。然而，背景实质强化（BPE）现象仍是影像解读中的关键考量因素，因其可能遮蔽或模拟病灶而影响诊断。虽然BPE在磁共振成像中的影响已有充分研究，但关于CEM中影响BPE的因素及其与乳腺癌特征相关性的数据仍较为有限。 材料与方法：本回顾性研究纳入116例经活检及手术确诊的浸润性乳腺癌患者，所有患者均在术前接受CEM检查。收集数据包括患者年龄、乳腺密度、受体状态、肿瘤分级及Ki-67增殖指数。由两名放射科医师采用2022版ACR BI-RADS CEM词典对BPE进行评估。通过统计分析探究BPE与患者人口学特征及肿瘤特性之间的关联。 结果：研究发现较高水平的BPE与特定患者特征存在显著关联。具体而言，乳腺密度较高（p<0.001）及绝经前状态（p=0.029）的患者更常出现BPE增强。在乳腺密度分级为B类的患者中，多数表现为轻度BPE，而C类和D类患者则呈现渐进性增强趋势，表明乳腺密度与强化程度存在明确正相关。此外，与绝经后患者相比，绝经前患者出现中度至显著BPE的可能性更高。尽管存在这些显著关联，分析未发现BPE强度与肿瘤亚型（p=0.77）或肿瘤分级（p=0.73）存在有意义的相关性。BPE评估的观察者间一致性较高，加权Kappa值为0.78（95% CI：0.68-0.89），表明放射科医师评估结果具有良好的一致性。 结论：本研究表明CEM中的BPE受乳腺密度及年龄等因素影响，这与MRI研究中的观察模式相符。但BPE强度与肿瘤亚型或分级无关，提示其预后价值有限。这些发现凸显了BPE作为预防性随访风险生物标志物的潜力，尤其对于高乳腺密度及绝经前状态的患者。未来需要多中心前瞻性研究验证这些结果，并深化对BPE在CEM诊断中作用的理解。
肿瘤(癌症)患者之家