This prospective study assessed photon-counting CT for pretreatment breast cancer in 126 women with lesions categorised BI-RADS 4C or higher, all of whom also underwent breast MRI, with FDG PET/CT in a subset with locally advanced disease. Four radiologists read independently.
Agreement between readers was good to excellent. Photon-counting CT agreed closely with MRI for lesion characterisation and clinical T category, and correlated well with pathological size. For 46 pathologically confirmed additional lesions it was substantially more sensitive than mammography (difference 44%, 95% CI 19 to 66) and similar to MRI. For nodal metastasis it outperformed MRI on both sensitivity (difference 10%) and accuracy (difference 6%), and agreed closely with PET/CT on N category.
The limitation is specific and important: 44% of microcalcifications seen on mammography were missed on photon-counting CT. Microcalcifications are how ductal carcinoma in situ and a substantial share of early disease present, so this is not a marginal gap — it defines what the modality cannot replace. Read as a whole, this positions photon-counting CT as a promising single-study staging tool, potentially covering local extent and nodal status together, rather than as a substitute for mammography. It is a feasibility study in 126 patients, so it establishes plausibility rather than a role.
- Comparable to MRI for lesion characterisation and T category
- Better than MRI for nodal metastasis (sensitivity difference 10%)
- 44% of microcalcifications seen on mammography were missed
- Feasibility study in 126 women — plausibility, not a defined role
The statistics, in plain English
The confidence interval on the mammography comparison, 19 to 66 percentage points, is very wide because only 46 confirmed additional lesions were available — so the direction is clear and the magnitude is not. The nodal advantage, with an interval of 1 to 20 points, only just excludes zero and rests on a small number of confirmed metastases. Treat every number here as provisional; the microcalcification finding is the one robust enough to act on.
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