To assess the diagnostic value of contrast-enhanced spectral mammography (CESM) features in breast carcinoma by analyzing the CESM features of benign and malignant breast tumors.

A retrospective analysis was performed on 138 female patients with clinically suspected breast tumors in Tai′an Central Hospital from July 2017 to March 2019. The breast tumors were evaluated and classified according to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) standard. Based on the pathological results of surgery or biopsy, the degree (mild, moderate, and severe), density (homogeneous and heterogeneous), and pattern of enhancement (typeⅠpersistent, typeⅡplateau, and typeⅢ washout) of different tumors were statistically analyzed. The Chi-square test was applied to analyze the different features between the benign tumors group, carcinoma in situ (DCIS) group, and invasive carcinoma group.

A total of 147 breast tumors were confirmed by pathology, including 40 benign tumors, 86 invasive carcinomas, and 21 DCIS. Approximately 96.5% (83/86) of invasive carcinomas, 42.9% (9/21) of DCIS, and 15.0% (6/40) of benign tumors showed moderate or severe enhancement (χ²=87.878, P<0.001); 91.9% (79/86) of invasive carcinomas, 85.7%(18/21) of DCIS, and 73.5% (25/34) of benign tumors showed heterogeneous enhancement (including ring enhancement) (χ²=7.036, P=0.030); 90.7% (78/86) of invasive carcinomas, 47.6% (10/21) of DCIS, and 32.4% (11/34) of benign tumors showed typeⅡor Ⅲ enhancement (χ²=45.683, P<0.001). The sensitivity of moderate or severe enhancement for the diagnosis of breast invasive cancer, DCIS, and benign tumors was 96.5% (83/86), 42.9% (9/21), and 17.6% (6/34), respectively; the sensitivity of heterogeneous enhancement was 91.9%, 85.7%, and 73.5%, respectively, and the sensitivity of typeⅡorⅢ enhancement was 90.7% (79/86), 47.6% (10/21), and 32.4% (11/34), respectively.

Moderate or severe enhancement, heterogeneous enhancement, and typeⅡor Ⅲ enhancement on CESM are valuable for the diagnosis of invasive breast cancer.