Cone Beam Breast CT in Differentiating Benign Breast Diseases with Different Breast Cancer Risks

Aim: To differentiate benign breast diseases with various levels of breast cancer risk using cone-beam breast computed tomography (CBBCT) imaging characteristics. Methods: One hundred and seven (107) cases of confirmed benign breast diseases were divided into High-Risk (HR), Elevated-Risk (ER), and Low-Risk (LR) groups based on their histopathologic types and previously reported breast cancer risk levels of these types. The general clinicopathological features, CBBCT imaging characteristics, and quantitative measurements of the three groups were statistically analyzed. Results: Although the majority of the lesions in all the risk groups showed benign morphological and descriptive enhancement characteristics based on BI-RADS® lexicon, the three risk groups could not be discriminated by both non-contrast CBBCT and Contrast-Enhanced CBBCT (CE-CBBCT) morphological characteristics and descriptive enhancement characteristics. However, CE-CBBCT quantitative enhancement measurements including Enhancement Degree (D E ) and Wash-in Rate (R W ) were able to differentiate the lesions in the three risk groups with statistically significant differences (P < 0.05). The D E at phase 1 post-contrast scan is the highest in ER group (0.346), followed by HR group (0.329) and lowest in LR group (0.106). The R W at phase 1 post-contrast scan is the highest in ER group (1.171), followed by HR group (1.018) and LR group (0.267). The R W at phase 1 post-contrast scan is the highest in HR group (0.604), followed by LR group (0.260) and ER group (0.074). Conclusions: The quantitative enhancement measurements in CE-CBBCT images can be used to differentiate LR, ER and HR groups among benign breast diseases. The outcome of the study could be useful to reduce the overtreatment of benign lesions and customize treatment plans based on breast cancer risk levels.