Comparative study between contrast-enhanced mammography, tomosynthesis, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma

Abstract

Background: Mammography is accused of having low sensitivity and specificity in dense breast parenchyma. Also, women with dense breasts show an increased risk of developing breast cancer. Breast ultrasound has been used for several years for a better characterization of breast lesions. Contrast-enhanced mammography and tomosynthesis are relative novel imaging techniques that have been implicated in breast cancer detection and diagnosis. We aimed to compare breast tomosynthesis, contrast-enhanced mammography, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma. Results: The study included 37 patients with 63 inconclusive mammography breast lesions. They all performed contrast-enhanced mammography, single-view tomosynthesis, and breast ultrasound. Mammography had a sensitivity of 83%, a specificity of 48%, a positive predictive value of 68%, a negative predictive value of 68%, and a diagnostic accuracy of 68%. Contrast-enhanced mammography had a sensitivity of 89%, a specificity of 89%, a positive predictive value of 91%, a negative predictive value of 86%, and a diagnostic accuracy of 89%. Tomosynthesis had a sensitivity of 86%, a specificity of 81%, a positive predictive value of 86%, a negative predictive value of 81%, and a diagnostic accuracy of 84%. Breast ultrasound had a sensitivity of 97%, a specificity of 85%, a positive predictive value of 90%, a negative predictive value of 96%, and a diagnostic accuracy of 92%. Conclusion: Breast ultrasound, tomosynthesis, and contrast-enhanced mammography showed better performance compared to mammography in dense breasts. However, ultrasound being safe with no radiation hazards should be the second step modality of choice after mammography in the assessment of mammography dense breasts. Adding tomosynthesis to mammography in screening increases its sensitivity. Contrast-enhanced mammography should be reserved for cases with inconclusive sonomammographic results.

Diagnostic performance of contrast‐enhanced mammography for suspicious findings in dense breasts: A systematic review and meta‐analysis

“…A total of 827 patients with 958 lesions, ranging in age from 15 to 78 years, were included. Among the included studies, three 11 , 15 , 19 were retrospective studies, and the remaining seven 12 , 13 , 14 , 16 , 17 , 18 , 20 were prospective studies. Table 1 and Additional Files S2 and S3 show the characteristics of the included studies.…”

“…Seven studies 11 , 12 , 13 , 15 , 17 , 18 , 20 reported the CEM findings of benign and malignant lesions. In the analysis of 609 lesions, the relative malignancy OR value of the enhanced lesions was 28.11 (95% CI, 6.84–115.48).…”

“…The details of the risk of bias and clinical applicability of each study are shown in Figure 2. Three studies 12,13,18 were at a high risk of bias, and the remaining seven studies were at a low risk. All the studies had high clinical applicability.…”

Comparative study between conventional ultrasound strain elastography and an AI-enabled elastography software in differentiating breast masses

“…Breast ultrasound is a non-invasive, relatively available imaging modality that is used as complementary to mammography in screening especially in dense breasts, differentiation of solid and cystic lesions, characterization of lesions, and diagnosis of intraductal mass as well as problem-solving for mammographically detected asymmetries [12,13].…”

MRI-Guided Breast Biopsy-Histopathological Verification of Suspicious Breast Lesions Visible on MRI Only

“…According to European Society of Breast Imaging recommendations mammography is a basic diagnostic method of clinically asymptomatic breast cancer [1]. However, it is worth remembering, that sensitivity and specificity of mammography is limited, mostly by dense breast anatomy [2,3]. Therefore, other modalities are applied, such as ultrasonography and MRI [4,5].…”