Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer

Abstract

ammography is the primary imaging modality used for breast cancer screening and is the only imaging test shown to reduce mortality from breast cancer (1-3). Although effective, one major limitation of mammography is its limited sensitivity, especially in women with dense breasts. The sensitivity of mammography in young women with dense breasts is reported to be as low as 38%-50% (4,5).Breast MRI is known to be the most sensitive imaging modality to detect breast cancer. However, breast MRI is restricted to screening women at high risk and, more recently, women with a personal history of breast cancer and dense breasts or who are diagnosed before age 50 years primarily because of its high cost and limited availability (6-14). Contrast agent-enhanced digital mammography (DM)(CEDM) is a contrast agent-based imaging test performed by using a modified DM unit. Studies (15-18) have reported that CEDM had improved sensitivity and specificity compared with conventional mammography in the diagnostic setting. To our knowledge, only two studies have evaluated the use of screening CEDM. The first study ( 19) was a small study of 307 women that compared screening CEDM with breast MRI and found that both CEDM and MRI depicted cancers not seen at conventional mammography. A more recent study (20) evaluated the performance of screening CEDM in 611 women at intermediate risk. In that study, CEDM was more sensitive than standard DM, with the addition of contrast enhancement resulting in an incremental cancer detection rate of 13.1 of 1000. The overall cancer detection rate in that study was high, at 31 of 1000 (19 cancers in 611 women).CEDM has been offered as a screening test at our Comprehensive Cancer Center since December 2012. Referring physicians may order CEDM as an alternative screening examination to conventional mammography. CEDM is most commonly performed to screen women at intermediate risk such as women with a

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

“…The pooled sensitivity of CEDM was 98% (95% CI, 96%‐100%), with a pooled specificity being moderate at 58% (95% CI, 38%‐77%). 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…”

Comparative study between contrast-enhanced mammography, tomosynthesis, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma

“…Our results were comparable to a study performed by Sung et al [20]; their study included 904 CEM studies for women of high breast cancer risk. They concluded that sensitivity of contrast agent-enhanced mammography was 87.5% (compared with 50.0% for digital mammography) with a specificity of 93.7%.…”

Dual Energy X-ray Methods for the Characterization, Quantification and Imaging of Calcification Minerals and Masses in Breast

“…The dual energy contrast enhanced technique was used in clinical practice. Women with breast lesions undergone dual energy contrast enhanced mammography [23,37,[92][93][94][95][96][97][98]. The results of all studies indicated that dual energy contrast enhanced technique could improve the visibility of breast lesions.…”

“…Sung et al evaluated the performance of contrast enhanced digital mammography for breast cancer screening [98]. In this study, 904 women undergone contrast enhanced digital mammography with a commercially available digital mammography unit (Senographe Essential; GE Medical Systems, Milwaukee, Wis) ( Figure 5b) after their medical records' review for age, risk factors, short-interval follow-up and biopsies recommended, and cancers detected.…”