Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery

Abstract

To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM.

Radiation Dose of Contrast-Enhanced Mammography: A Two-Center Prospective Comparison

“…While concerns about risks associated with the exposure to ionizing radiation are limited and outweighed by potential benefits when an imaging technique is used in symptomatic patients or for characterizing suspicious findings, cancer staging, or neoadjuvant therapy evaluation [ 1 , 6 , 7 ], dose assessment becomes far more important if an imaging technique (in this case, CEM) is used to image healthy subjects, as occurs in screening populations [ 12 , 13 , 14 , 15 , 16 , 17 ]. Thus, assessment of the CEM radiation dose is crucial for defining its clinical application field.…”

Outcomes of breast conserving therapy: Recurrence, imaging findings and histological correlation

“… 5 , 44 , 45 We anticipate that the use of contrast enhanced mammogram at our institution will assist in improving diagnostic imaging accuracy. 46 Features which correlated with benign breast changes included absence of skin thickening (> 3 mm), indistinct and coarse calcifications, absence of lymphadenopathy.…”

Prospective Multicenter Diagnostic Performance of Technologist-Performed Screening Breast Ultrasound After Tomosynthesis in Women With Dense Breasts (the DBTUST)

“…Importantly, when screening MRI is performed, screening US has no added benefit. [43][44][45] Although contrast-enhanced mammography has been proposed for screening women at intermediate risk, including women with dense breasts, 46,47 personal history of breast cancer, 48 or prior lobular neoplasia, 49 the evidence that is available to support this recommendation is limited to a few retrospective studies. Added CDR from contrast in these series (that included a mix of prevalence and incidence rounds) averaged 9.7/1,000 (27/2,792) with an added falsepositive rate because of contrast of 6.5% (171/2,631).…”