Digital Mammography Versus Contrast Enhanced Spectral Mammography in the Evaluation of Cases with Suspicious Breast Calcifications and Impact on Surgeon’s Decision.

Background: Digital mammography (DM) remains the gold standard for detecting breast microcalcifications, its ability to differentiate between benign and malignant types based solely on morphology and distribution can be limited. Contrast-enhanced spectral mammography (CESM) emerges as a promising approach by incorporating pathological contrast enhancement, potentially leading to a more confident diagnosis compared to DM, and offering a faster and potentially more cost-effective alternative to breast magnetic resonance imaging. Patients and methods: This cross-sectional study included 50 female patients with suspicious breast calcifications (BIRADS 4B, 4C, 4, or 5). CESM was performed, and images were analyzed for lesion characteristics. Histopathological results served as the gold standard for comparison, guiding surgical decisions and treatment plans. Results: This study included 50 patients who had suspicious breast calcifications detected by DM, with 54 breast lesions. All patients performed DM and CESM. None of them had adverse reactions. Out of the 54 identified breast lesions, 19/54, 35% were benign and 35/54, 65% were malignant. The calculated sensitivity, specificity, positive and negative predictive values and total accuracy of DM were 91.4%, 70.8%, 62.7%, 93.9%, and 78% respectively as compared to 85.7%, 90.7%, 83.3%, 92.2%, and 89% for CESM. When adding CESM to DM the calculated diagnostic indices were raised to 100%, specificity was 90.7 %, PPV was 83.3% and NPV raised to 100%. Conclusion: Combining CESM with DM while evaluating suspicious breast microcalcifications can increase both the sensitivity and specificity of cancer detection. CESM significantly influenced surgical decisions in cases where multicentricity was detected by CESM but missed in initial mammography reports, particularly in patients with dense breasts.