Contrast-Enhanced Mammography (CEM) for Detecting Residual Disease after Neoadjuvant Chemotherapy: A Comparison with Breast Magnetic Resonance Imaging (MRI)

Abstract

Objective To evaluate the performance of contrast-enhanced mammography (CEM) compared to magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in women with newly diagnosed breast cancer. Methods The institutional review board approved this study. This prospective study included women with newly diagnosed breast cancer who underwent breast CEM and MRI at the end of the last cycle of NAC and before definitive surgery. Size of residual malignancy on post-NAC CEM and MRI was compared with surgical pathology. Agreements and correlations of CEM and MRI measurements with histological size were assessed. Results Thirty-three patients were included with a mean age of 45 years (range 22–76). The sensitivity, specificity, and positive and negative predictive value for detection of residual disease of CEM were 76%, 87.5%, 95%, and 86.4%, and those of MRI were 92%, 75%, 92%, and 75%. Comparing CEM to MRI, the mean difference was −0.8 cm, concordance coefficient was 0.7, and Pearson correlation was 0.7 (p = 0.0003). The concordance coefficient between measurements of each imaging modality and pathologic tumor size was 0.7 for CEM and 0.4 for MRI. Pearson correlation was 0.8 for CEM and 0.5 for MRI. Mean differences between CEM, MRI, and residual histopathological tumor size were 0.8 cm and 1.8 cm, respectively. Conclusions CEM has good correlation and agreement with histopathology for measuring residual disease after NAC. CEM was comparable to MRI, showing high positive predictive value and specificity for detecting residual disease.

Evolving Role of Magseed in Wireless Localization of Breast Lesions: Systematic Review and Pooled Analysis of 1,559 Procedures

“…This may hamper the detection of residual disease after neoadjuvant systemic therapy if MRI is required for monitoring response to treatment. Nevertheless, contrast-enhanced mammography is an effective alternative imaging modality which may be considered if signal void artefacts pose a significant issue (38). The Savi Scout system is another non-wire nonradioactive alternative.…”

Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis

“…Other analyses will be required to assess the value of CESM in other settings, such as screening programmes, especially for groups of women at increased risk of breast cancer who do not currently qualify for MRI screening, and those with dense mammographic background patterns [ 58 ]. In addition, the CESM monitoring response to neoadjuvant chemotherapy for patients who are unable to undergo MRI may offer a useful alternative [ 60 , 61 ]. Finally, computer-aided diagnosis systems are being developed using CESM, which may further help the unexperienced reader interpreting images [ 62 ].…”

Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review

“…Original studies have investigated the use of CESM in a number of settings, such as evaluation of symptomatic women [14–17], screening recalls [18–22], local staging [23–32], pre- and post-operative evaluations [23, 24, 33–36] and neoadjuvant chemotherapy response monitoring [37–40]. In 2016, a first meta-analysis on CESM described a high pooled sensitivity (98%) albeit with a relatively low specificity (58%) [41], the latter partly caused by inexperience.…”