{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:35:35Z","timestamp":1787027735280,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T00:00:00Z","timestamp":1630281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The contrast-enhanced mammographic features of ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) manifesting microcalcifications only on mammograms were evaluated to determine whether they could predict IDC underestimation. Methods: We reviewed patients who underwent mammography-guided biopsy on suspicious breast microcalcifications only and received contrast-enhanced spectral mammography (CESM) within 2 weeks before the biopsy. Those patients who were proven to have cancers (DCIS or IDC) by biopsy and subsequently had surgical treatment in our hospital were included for analysis. The presence or absence, size, morphology and texture of enhancement on contrast-enhanced spectral mammography were reviewed by consensus of two radiologists. Results: A total of 49 patients were included for analysis. Forty patients (81.6%) showed enhancement, including 18 (45%) DCIS and 22 (55%) IDC patients. All nine unenhanced cancers were pure DCIS. Pure DCIS showed 72.22% nonmass enhancement and 83.33% pure ground glass enhancement. IDC showed more mass (72.2% vs. 27.8%) and solid enhancements (83.33% vs. 16.67%). The cancer and texture of enhancement were significantly different between pure DCIS and IDC, with moderate diagnostic performance for the former (p-value &lt; 0.01, AUC = 0.66, sensitivity = 93%, specificity = 39%) and the latter (p-value &lt; 0.01, AUC = 0.74, sensitivity = 65%, specificity = 83%). Otherwise, pure DCIS showed a significant difference in enhanced texture compared with upgraded IDC and IDC (p = 0.0226 and 0.0018, respectively). Conclusions: Nonmass and pure ground glass enhancements were closely related to pure DCIS, and cases showing mass and unpurified solid enhancements should be suspected as IDC. Unenhanced DCIS with microcalcifications only has a low DCIS upgrade rate. The CESM-enhanced features could feasibly predict IDC underestimation.<\/jats:p>","DOI":"10.3390\/cancers13174371","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T11:01:37Z","timestamp":1630321297000},"page":"4371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Contrast-Enhanced Mammographic Features of In Situ and Invasive Ductal Carcinoma Manifesting Microcalcifications Only: Help to Predict Underestimation?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6870-3429","authenticated-orcid":false,"given":"Yun-Chung","family":"Cheung","sequence":"first","affiliation":[{"name":"Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Medical College of Chang Gung University, 5 Fuxing St., Guishan, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kueian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Medical College of Chang Gung University, 5 Fuxing St., Guishan, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2565-4305","authenticated-orcid":false,"given":"Chi-Chang","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, 5 Fuxing St., Guishan, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shir-Hwa","family":"Ueng","sequence":"additional","affiliation":[{"name":"Department of Pathology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, 5 Fuxing St., Guishan, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Wei","family":"Li","sequence":"additional","affiliation":[{"name":"Research Group, GE Health Care, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin-Cheh","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, 5 Fuxing St., Guishan, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/cncr.11887","article-title":"Stereotactic vacuum- assisted breast biopsy in 2874 patients: A multicenter study","volume":"100","author":"Kettritz","year":"2004","journal-title":"Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2214\/ajr.171.1.9648759","article-title":"The breast imaging reporting and data system: Positive predictive value of mammographic features and final assessment categories","volume":"171","author":"Liberman","year":"1998","journal-title":"AJR Am. 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