Background/Objectives: The aim of this study is to evaluate the impact of tumor characteristics on lesion conspicuity in contrast-enhanced mammography (CEM) and identify factors associated with different levels of conspicuity. Methods: In this retrospective study, we analyzed 552 patients with breast cancer who underwent CEM. Lesion conspicuity was categorized into three levels: 1 (low), 2 (moderate), and 3 (high). Tumor characteristics included age, histological subtype, hormone receptor status, HER2 status, Ki67 index, tumor grade, and molecular subtype. Univariate and multivariate analyses were conducted to assess associations between lesion conspicuity and these factors. Results: Of the 552 cases, the majority showed mass enhancement (78.1%), followed by non-mass enhancement (NME) (16.8%), and a combination of mass and NME (4.0%). Lesion conspicuity was significantly associated with enhancement type on CEM (p< 0.001). High conspicuity (score 3) was predominantly observed in masses (84.8%) compared to NME (7.6%). Larger tumor dimensions (median 20 mm) were also associated with higher conspicuity (p< 0.001). Molecular subtypes differed significantly in conspicuity, with Luminal A tumors showing lower conspicuity compared to HER2-positive and triple-negative breast cancers (p= 0.025). In multivariate analysis, lesion conspicuity was strongly associated with enhancement type (p< 0.001) and tumor dimensions (p< 0.001), while histological subtype and molecular characteristics had no significant independent impact. Conclusions: Lesion conspicuity in CEM is primarily influenced by the type of enhancement and tumor size. Mass-forming lesions, particularly larger ones, are more conspicuous, while NME tends to result in lower conspicuity. These findings suggest that enhancement patterns and tumor dimensions are key factors to consider when interpreting CEM in breast cancer diagnosis.
背景/目的：本研究旨在评估肿瘤特征对对比增强乳腺X线摄影（CEM）中病灶显著性的影响，并识别与不同显著性水平相关的因素。方法：在这项回顾性研究中，我们分析了552例接受CEM检查的乳腺癌患者。病灶显著性分为三个等级：1级（低）、2级（中）和3级（高）。肿瘤特征包括年龄、组织学亚型、激素受体状态、HER2状态、Ki67指数、肿瘤分级和分子亚型。通过单因素和多因素分析评估病灶显著性与这些因素之间的关联。结果：在552例病例中，大多数表现为肿块强化（78.1%），其次是非肿块强化（16.8%），以及肿块与非肿块强化并存（4.0%）。病灶显著性与CEM上的强化类型显著相关（p<0.001）。高显著性（3级）主要见于肿块（84.8%），而非肿块强化仅占7.6%。较大的肿瘤尺寸（中位数20毫米）也与较高的显著性相关（p<0.001）。不同分子亚型的显著性存在显著差异，Luminal A型肿瘤的显著性低于HER2阳性和三阴性乳腺癌（p=0.025）。在多因素分析中，病灶显著性与强化类型（p<0.001）和肿瘤尺寸（p<0.001）密切相关，而组织学亚型和分子特征无显著独立影响。结论：CEM中病灶显著性主要受强化类型和肿瘤大小的影响。肿块型病变，尤其是较大的肿块，显著性更高，而非肿块强化往往导致显著性降低。这些发现表明，在乳腺癌诊断中解读CEM时，强化模式和肿瘤尺寸是需要考虑的关键因素。
肿瘤(癌症)患者之家