Newly Diagnosed Breast Cancer: Comparison of Contrast-enhanced Spectral Mammography and Breast MR Imaging in the Evaluation of Extent of Disease

Abstract

Purpose To compare the diagnostic performances of contrast material-enhanced spectral mammography and breast magnetic resonance (MR) imaging in the detection of index and secondary cancers in women with newly diagnosed breast cancer by using histologic or imaging follow-up as the standard of reference. Materials and Methods This institutional review board-approved, HIPAA-compliant, retrospective study included 52 women who underwent breast MR imaging and contrast-enhanced spectral mammography for newly diagnosed unilateral breast cancer between March 2014 and October 2015. Of those 52 patients, 46 were referred for contrast-enhanced spectral mammography and targeted ultrasonography because they had additional suspicious lesions at MR imaging. In six of the 52 patients, breast cancer had been diagnosed at an outside institution. These patients were referred for contrast-enhanced spectral mammography and targeted US as part of diagnostic imaging. Images from contrast-enhanced spectral mammography were analyzed by two fellowship-trained breast imagers with 2.5 years of experience with contrast-enhanced spectral mammography. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated for both imaging modalities and compared by using the Bennett statistic. Results Fifty-two women with 120 breast lesions were included for analysis (mean age, 50 years; range, 29-73 years). Contrast-enhanced spectral mammography had similar sensitivity to MR imaging (94% [66 of 70 lesions] vs 99% [69 of 70 lesions]), a significantly higher PPV than MR imaging (93% [66 of 71 lesions] vs 60% [69 of 115 lesions]), and fewer false-positive findings than MR imaging (five vs 45) (P < .001 for all results). In addition, contrast-enhanced spectral mammography depicted 11 of the 11 secondary cancers (100%) and MR imaging depicted 10 (91%). Conclusion Contrast-enhanced spectral mammography is potentially as sensitive as MR imaging in the evaluation of extent of disease in newly diagnosed breast cancer, with a higher PPV. RSNA, 2017.

A meta‐analysis of contrast‐enhanced spectral mammography versus MRI in the diagnosis of breast cancer

“…After a systematic search of the relevant electronic databases, 534 publications were initially identified, and after removal of duplicated data, studies and noncorrelated studies, 13 diagnostic publications were identified and included in the final meta‐analysis (Fig ). Of those included, five were retrospective studies and the other eight were prospective work.…”

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

“…CEM has been proposed as an alternative to MRI due to its shorter exam time, better tolerance, lower price, and reading time. CEM has been demonstrated to be comparable to MRI regarding cancer detection and evaluation of disease extent [ 8 , 13 – 16 ].…”

“…Contrast-enhanced mammography (CEM) is a new imaging tool that uses a dual-energy technique to combine the benefits of digital mammography with intravenous contrast utilization. In the diagnostic setting, CEM has a higher sensitivity for breast cancer detection compared with the sensitivities of full-field digital mammography (FFDM) alone and FFDM combined with ultrasound [ 7 – 16 ]. For assessing tumor extent, CEM findings were reported to have good correlation with histopathology size, even in dense breasts, and this correlation was better than those for FFDM and US [ 17 ].…”

“…For assessing tumor extent, CEM findings were reported to have good correlation with histopathology size, even in dense breasts, and this correlation was better than those for FFDM and US [ 17 ]. CEM has been shown to detect breast cancer with a diagnostic accuracy that is comparable or even better than breast MRI, even in dense breasts [ 7 , 8 , 15 , 16 ].…”

Practical uses of contrast‐enhanced spectral mammography in daily work: A pictorial review

“…Demonstration of multifocal or multicentric disease is also important for surgical planning. A recent study by Lee‐Felker et al . in which 52 women with newly diagnosed breast cancer underwent CESM and contrast enhanced MRI for local staging found that CESM had similar sensitivity to MRI (94% vs 99%, respectively), a higher PPV than MRI (93% vs 60%) and fewer false positives (5 vs 45) when assessing the extent of disease.…”