Staging of breast cancer in the breast and regional lymph nodes using contrast-enhanced photon-counting detector CT: accuracy and potential impact on patient management

• Published in: British journal of radiology 2024-01, Vol.97 (1153), p.93-97
• Main Authors: Yalon, Mariana, Sae-Kho, Tiffany, Khanna, Akriti, Chang, Shaojie, Andrist, Boleyn R, Weber, Nikkole M, Hoodeshenas, Safa, Ferrero, Andrea, Glazebrook, Katrina N, McCollough, Cynthia H, Baffour, Francis I
• Format: Article
• Language: English
• Subjects: Adult; Breast; Breast Neoplasms; Calcinosis; Female; Humans; Lymph Nodes; Lymphadenopathy; Middle Aged; Short Communication; Tomography, X-Ray Computed
• ISSN: 0007-1285; 1748-880X; 1748-880X
• DOI: 10.1093/bjr/tqad042

To describe the feasibility and evaluate the performance of multiphasic photon-counting detector (PCD) CT for detecting breast cancer and nodal metastases with correlative dynamic breast MRI and digital mammography as the reference standard. Adult females with biopsy-proven breast cancer undergoing staging breast MRI were prospectively recruited to undergo a multiphasic PCD-CT using a 3-phase protocol: a non-contrast ultra-high-resolution (UHR) scan and 2 intravenous contrast-enhanced scans with 50 and 180 s delay. Three breast radiologists compared CT characteristics of the index malignancy, regional lymphadenopathy, and extramammary findings to MRI. Thirteen patients underwent both an MRI and PCD-CT (mean age: 53 years, range: 36-75 years). Eleven of thirteen cases demonstrated suspicious mass or non-mass enhancement on PCD-CT when compared to MRI. All cases with metastatic lymphadenopathy (3/3 cases) demonstrated early avid enhancement similar to the index malignancy. All cases with multifocal or multicentric disease on MRI were also identified on PCD-CT (3/3 cases), including a 4 mm suspicious satellite lesion. Four of five patients with residual suspicious post-biopsy calcifications on mammograms were detected on the UHR PCD-CT scan. Owing to increased field-of-view at PCD-CT, a 5 mm thoracic vertebral metastasis was identified at PCD-CT and not with the breast MRI. A 3-phase PCD-CT scan protocol shows initial promising results in characterizing breast cancer and regional lymphadenopathy similar to MRI and detects microcalcifications in 80% of cases. UHR and spectral capabilities of PCD-CT may allow for comprehensive characterization of breast cancer and may represent an alternative to breast MRI in select cases.