Contrast-enhanced digital breast tomosythesis and breast MRI to monitor response to neoadjuvant chemotherapy: patient tolerance and preference

Abstract

Objectives: Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel imaging technique, combining contrast-enhanced spectral mammography (CESM) and tomosynthesis. This may offer an alternative imaging technique to breast MRI for monitoring of response to neoadjuvant chemotherapy. This paper addresses patient experience and preference regarding the two techniques. Methods: Conducted as part of a prospective pilot study; patients were asked to complete questionnaires pertaining to their experience of CE-DBT and MRI following pre-treatment and end-of-treatment imaging. Questionnaires consisted of eight questions answered on a categorical scale, two using a visual analogue scale (VAS), and a question to indicate preference of imaging technique. Statistical analysis was performed with SPSS v25 Wilcoxon signed rank test and McNemar test for related samples using SPSS v25. Results: Eighteen patients were enrolled in the pilot study. Matched CE-DBT and MRI questionnaires were completed after 22 patient episodes, patient preference was indicated after 31 patient episodes. Overall, on 77% of occasions patients preferred CE-DBT with no difference between pre-treatment and end-of-treatment imaging. Overall experience (p = 0.008), non-breast pain (p = 0.046), anxiety measured using VAS (p = 0.003), and feeling of being put at ease by staff (p = 0.023) was better for CE-DBT. However, more breast pain was experienced during CE-DBT when measured on both VAS (p = 0.011) and Likert scale (p = 0.021). Conclusion: Our paper suggests that patients prefer CE-DBT to MRI, adding further evidence in favour of contrast-enhanced mammographic techniques. Advances in knowledge: Contrast mammographic techniques offer an alternative, more accessible imaging technique to breast MRI. Whilst other studies have addressed patient experience of CESM, this is the first study to directly explore patient preference for contrast-enhanced DBT over MRI in the setting of neoadjuvant chemotherapy, finding that overall, patients preferred CE-DBT despite the need for longer breast compression.

Predicting the response to neoadjuvant chemotherapy. Can the addition of tomosynthesis improve the accuracy of contrast-enhanced spectral mammography? A comparison with breast MRI

“…Although not the focus of this study, we demonstrated through patient feedback questionnaires, a high acceptance of CEM+DBT as an imaging technique and a preference for it compared with CE-MRI. 15 This further supports the feasibility of CEM+DBT as a treatment monitoring modality.…”

Costing analysis to introduce a Contrast Enhanced Mammography service in place of existing breast MRI service for local staging of breast cancer

“…As a technique it is more time-efficient and often preferred by patients. [11][12][13] Furthermore, switching to CESM would reduce the pressure on MRI services for other imaging studies.…”

“…Emerging evidence from three studies of between 18 and 49 participants, demonstrates patient preference for CESM over MRI. 11–13 This adds further weight to the argument that it may be appropriate to use CESM instead of MRI for loco-regional staging.…”

“…[8][9][10] This is reflected in national guidance, which states that 'CESM has comparable accuracy to dynamic contrast-enhanced MRI for T-staging and assessing for multiple tumour foci' 5 Emerging evidence from three studies of between 18 and 49 participants, demonstrates patient preference for CESM over MRI. [11][12][13] This adds further weight to the argument that it may be appropriate to use CESM instead of MRI for loco-regional staging.…”

Comparative Evaluation of Contrast-Enhanced Spectral Mammography and Digital Breast Tomosynthesis for Diagnosing and Treating Breast Cancer

“…It has been reported that CEM has high specificity and sensitivity, and may have broader prospects in evaluating the response to neoadjuvant therapy [ 9 ]. However, CEM also has limitations, such as anaphylaxis and extravasation of contrast agents, increased radiation dose during multiple evaluations of response to neoadjuvant breast cancer, and inability to fully evaluate axillary lymph nodes and display lesions close to the chest wall or the medial breast [ 10 ].…”