Contrast-Enhanced Spectral Mammography in Women With Intermediate Breast Cancer Risk and Dense Breasts

Sorin, Vera; Yagil, Yael; Yosepovich, Ady; Shalmon, Anat; Gotlieb, Michael; Neiman, Osnat Halshtok; Sklair‐Levy, Miri

doi:10.2214/ajr.17.19355

Cited by 126 publications

(87 citation statements)

References 39 publications

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“…Moreover, CEDM is used for screening in women with an increased risk of breast cancer, showing a NPV of 99.7% and an increased cancer detection (by 75%) compared to the low‐energy mammography, thanks to the addition of contrast enhancement . Similar results are reported by Sorin et al…”

Section: Discussionsupporting

confidence: 77%

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

et al. 2019

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To compare diagnostic performance of contrast-enhanced dual-energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast-enhanced MRI (DCE-MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3-5 at imaging or clinically suspicious). CEDM, DBT, and DCE-MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two-dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE-MRI. DCE-MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE-MRI and CEDM (P = .03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE-MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE-MRI. Dynamic information obtained by time-intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions. | 861 PETRILLO ET aL.

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Section: Discussionsupporting

confidence: 77%

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

et al. 2019

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“…On the basis of angiogenesis, breast lesions reveal enhancement and are highlighted on subtraction images by eliminating overlapping of breast fibroglandular tissues [4][5][6] . Accordingly, CESM dramatically improves the cancer detection and decreases the misdiagnosis rate, especially in dense breasts [7][8][9][10] .…”

mentioning

confidence: 99%

Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography

Liu

Huang

Zhang

et al. 2020

Sci Rep

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CESM is an emerging digital mammography technology with a high breast cancer detection and a limited diagnostic specificity. In order to improve specificity, we quantitatively assessed enhancement intensity of breast lesions with different pathological types and hormonal receptor status and evaluated the consistency of enhancement patterns between CESM and DCE-MRI. A total of 145 lesions were enrolled, consisting of 43 malignant (17 non-infiltrating cancers and 26 infiltrating cancers) and 99 benign lesions. The diagnostic performance of enhancement intensity in the former positions was significantly higher than that in the latter positions (AUC: 0.834 vs. 0.755, p = 0.0008). Infiltrating cancers showed the highest enhancement intensity, while benign lesions the lowest (mean CNR1: 7.6% vs. 2.7%; median CNR1: 6.8% vs. 2.7%). Enhancement intensity of ER or PR positive group was weaker than negative group, while HER-2 positive group was stronger than negative group. 28 patients with 28 lesions performed both CESM and DCE-MRI examinations, showing a coincidence rate of 64.2% and moderate agreement (k = 0.515) between CESM and DCE-MRI. In conclusion, quantitative analysis of enhancement characteristics is feasible to the diagnosis practice on CESM.

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“…Finally, while MRI is the most sensitive breast imaging method, being capable of detecting tumor angiogenesis through contrast enhancement [19][20][21][22][23], it is affected by high rates of false positive results [20][21][22][23]. In this regard, CESM, based on the differential enhancement of neoplastic and normal tissue and coupling sensitivity to specificity, could represent a novel reliable tool for early detection of breast tumors [7][8][9][10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with dense breasts, it has been recently shown that CESM is more sensitive than traditional imaging techniques, irrespective of patient menopausal status, and shows significantly lower false positive rates than MRI and in some preliminary study of the last years CESM, can replace the standard mammogram in symptomatic women [7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Clinical performance of contrast-enhanced spectral mammography in pre-surgical evaluation of breast malignant lesions in dense breasts: a single center study

Bozzini

Nicosia

Pruneri

et al. 2020

Breast Cancer Res Treat

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Purpose To compare the efficacy of contrast-enhanced spectral mammography, with ultrasound, full field digital mammography and magnetic resonance imaging in detection and size estimation of histologically proven breast tumors. Methods This open-label, single center, prospective study, included 160 dense breast women with at least one suspicious mammary lesion evaluated by ultrasound, full field digital mammography and magnetic resonance imaging in whom a mammary tumor was histologically proven after surgery performed at the European Institute of Oncology between January 2013 and December 2015. Following the complete diagnostic procedure, the patients were further investigated by contrastenhanced spectral mammography prior to surgery. Results Overall, the detection rate of malignant breast lesions (in situ and invasive) was 93.8% (165/176) for contrastenhanced spectral mammography, 94.4% (168/178) for ultrasound, 85.5 (147/172) for full field digital mammography and 97.7% (173/177) for magnetic resonance imaging. Radiological measurements were concordant with the post-surgical pathological measurements of the invasive tumor (i.e., within 5 mm) in: 64.6% for contrast-enhanced spectral mammography, 62.0% for ultrasound, 45.2% for full field digital mammography (p < 0.0001) and 69.9% for magnetic resonance imaging (p = 0.28); underestimated in: 17.4% for contrast-enhanced spectral mammography, 19.6% for ultrasound, 24.2% for full field digital mammography (p = 0.03) and 6.7% for magnetic resonance imaging (p = 0.0005); and overestimated in: 16.2% for contrast-enhanced spectral mammography, 16.6% for ultrasound, 16.6% for full field digital mammography and 22.7% for magnetic resonance imaging (p = 0.02). Conclusions Our data suggest that contrast-enhanced spectral mammography improves on full field digital mammography and is comparable to ultrasound and magnetic resonance imaging in terms of detection sensitivity and size estimation of malignant lesions in dense breasts. Keywords Contrast-enhanced spectral mammography • Ultrasound • Full field digital mammography • Magnetic resonance • Breast malignant lesions Abbreviations CESM Contrast enhanced spectral mammography BC Breast cancer US Ultrasound MRI Magnetic resonance imaging FFDM Full field digital mammography BI-RADS Breast imaging reporting and data system VABB Vacuum-assisted breast biopsy CC Cranio-caudal MLO Medio-lateral-oblique

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Contrast-Enhanced Spectral Mammography in Women With Intermediate Breast Cancer Risk and Dense Breasts

Cited by 126 publications

References 39 publications

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography

Clinical performance of contrast-enhanced spectral mammography in pre-surgical evaluation of breast malignant lesions in dense breasts: a single center study

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