The value of contrast-enhanced energy-spectrum mammography combined with clinical indicators in detecting breast cancer in Breast Imaging Reporting and Data System (BI-RADS) 4 lesions.

Background: Under the Breast Imaging Reporting and Data System (BI-RADS), category 4 lesions have a high probability of malignancy. This study sought to investigate the efficacy of a model that combined the BI-RADS score with the enhancement score and clinical indicators in the diagnosis of BI-RADS 4 lesions based on contrast-enhanced spectral mammography (CESM) in breast cancer patients. Methods: The data of female patients with BI-RADS scores of 4 who underwent CESM at the Department of Medical Imaging of the Third Affiliated Hospital of Soochow University from January 2018 to July 2023 were retrospectively collected. In total, 170 patients were enrolled in the study. Based on their surgery or puncture pathology results, the patients were divided into malignant and benign groups. The clinical data, imaging characteristics, and enhancement degree of the patients in the two groups were compared. Model 3, which combined the BI-RADS score, enhancement score, and clinical indicators, was constructed using logistic regression. The predictive performance of Model 3 was evaluated and compared with Model 1 (BI-RADS score) and Model 2 (BI-RADS score + enhancement score). Results: Of the 170 patients, 69 had benign lesions and 101 had malignant lesions. There were significant differences between the malignant and benign groups in terms of age, menopause, a family history breast cancer, BI-RADS score, and enhancement score (all P<0.05). The areas under the curve (AUCs) of the receiver operator characteristic curves of Models 1, 2, and 3 were 0.830, 0.858, and 0.900, respectively. The best cut-off value for Model 3 was 0.766, with a sensitivity of 74.3% and a specificity of 94.2%. Based on the AUCs and decision curves, Model 3 performed better than Models 1 and 2. The calibration curve (intercept: 0.034; slope: 0.807) was plotted using bootstrap re-sampling (500 times), and showed good agreement between the predicted probability and the actual prevalence. Conclusions: In the suspected breast cancer patients with a BI-RADS score of 4, the combination of the enhancement score and clinical indicators based on the BI-RADS score improved the efficiency of CESM in diagnosing breast cancer.