A prospective single-centre study imaged 126 women with BI-RADS 4C or higher lesions using photon-counting CT (PCCT), MRI and mammography, with pathology as the reference.
PCCT agreed with MRI for lesion characterisation and T-staging, and for extra ipsilateral lesions it clearly beat mammography (sensitivity difference 44%, 95% CI 19 to 66) while matching MRI (difference 7%, 95% CI −5 to 21). It was slightly better than MRI for nodal metastasis (sensitivity difference 10%, 95% CI 1 to 20). The catch: PCCT missed 44% of microcalcifications seen on mammography (95% CI 27 to 52).
This is early, single-centre feasibility work, not a reason to reorganise breast imaging. It suggests PCCT could become an MRI-like problem-solver where MRI is contraindicated or unavailable, but it does not replace mammography, precisely because calcifications are where it fails.
- PCCT matched MRI for lesion characterisation and additional-lesion detection
- Modestly better than MRI for nodal metastasis
- Missed 44% of microcalcifications versus mammography — the key limitation
- 126 patients, single centre, prospective feasibility — not yet practice-changing
The statistics, in plain English
A 44% sensitivity difference versus mammography for extra lesions, with a confidence interval (19 to 66) that stays above zero, means the advantage is real but imprecisely sized in 126 patients. The same 44% figure for missed microcalcifications is a deficiency, not a benefit — read each difference by its direction, not its size alone.
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