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Open accessJournal ArticleDOI: 10.1148/RADIOL.2021201948

Contrast-enhanced Mammography: State of the Art.

02 Mar 2021-Radiology (Radiological Society of North America, Inc.)-Vol. 299, Iss: 1, pp 36-48
Abstract: Contrast-enhanced mammography (CEM) has emerged as a viable alternative to contrast-enhanced breast MRI, and it may increase access to vascular imaging while reducing examination cost. Intravenous iodinated contrast materials are used in CEM to enhance the visualization of tumor neovascularity. After injection, imaging is performed with dual-energy digital mammography, which helps provide a low-energy image and a recombined or iodine image that depict enhancing lesions in the breast. CEM has been demonstrated to help improve accuracy compared with digital mammography and US in women with abnormal screening mammographic findings or symptoms of breast cancer. It has also been demonstrated to approach the accuracy of breast MRI in preoperative staging of patients with breast cancer and in monitoring response after neoadjuvant chemotherapy. There are early encouraging results from trials evaluating CEM in the screening of women who are at an increased risk of breast cancer. Although CEM is a promising tool, it slightly increases radiation dose and carries a small risk of adverse reactions to contrast materials. This review details the CEM technique, diagnostic and screening uses, and future applications, including artificial intelligence and radiomics.

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Topics: Breast MRI (68%), Digital mammography (63%), Mammography (63%) ... show more
Citations
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11 results found


Open accessJournal ArticleDOI: 10.3390/CURRONCOL28040232
12 Jul 2021-Current Oncology
Abstract: Contrast-enhanced spectral mammography (CESM) is a promising, digital breast imaging method for planning surgeries. The study aimed at comparing digital mammography (MG) with CESM as predictive factors in visualizing multifocal-multicentric cancers (MFMCC) before determining the surgery extent. We analyzed 999 patients after breast cancer surgery to compare MG and CESM in terms of detecting MFMCC. Moreover, these procedures were assessed for their conformity with postoperative histopathology (HP), calculating their sensitivity and specificity. The question was which histopathological types of breast cancer were more frequently characterized by multifocality–multicentrality in comparable techniques as regards the general number of HP-identified cancers. The analysis involved the frequency of post-CESM changes in the extent of planned surgeries. In the present study, MG revealed 48 (4.80%) while CESM 170 (17.02%) MFMCC lesions, subsequently confirmed in HP. MG had MFMCC detecting sensitivity of 38.51%, specificity 99.01%, PPV (positive predictive value) 85.71%, and NPV (negative predictive value) 84.52%. The respective values for CESM were 87.63%, 94.90%, 80.57% and 96.95%. Moreover, no statistically significant differences were found between lobular and NST cancers (27.78% vs. 21.24%) regarding MFMCC. A treatment change was required by 20.00% of the patients from breast-conserving to mastectomy, upon visualizing MFMCC in CESM. In conclusion, mammography offers insufficient diagnostic sensitivity for detecting additional cancer foci. The high diagnostic sensitivity of CESM effectively assesses breast cancer multifocality/multicentrality and significantly changes the extent of planned surgeries. The multifocality/multicentrality concerned carcinoma, lobular and invasive carcinoma of no special type (NST) cancers with similar incidence rates, which requires further confirmation.

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Topics: Breast cancer (58%), Mammography (57%), Invasive carcinoma of no special type (54%) ... show more

2 Citations


Posted ContentDOI: 10.1038/S41598-021-01622-7
25 Jun 2021-Scientific Reports
Abstract: Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.

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Topics: Digital mammography (52%), Mammography (52%)

1 Citations


Open accessJournal ArticleDOI: 10.3390/JCM10215135
Abstract: It is time to reconsider how we image the breast. Although the breast is a 3D structure, we have traditionally used 2D mammography to perform screening and diagnostic imaging. Mammography has been continuously modified and improved, most recently with tomosynthesis and contrast mammography, but it is still using modifications of compression 2D mammography. It is time to consider 3D imaging for this 3D structure. Cone-beam breast computed tomography (CBBCT) is a revolutionary modality that will assist in overcoming the limitations of current imaging for dense breast tissue and overlapping structures. It also allows easy administration of contrast material for functional imaging. With a radiation dose on par with diagnostic mammography, rapid 10 s acquisition, no breast compression, and true high-resolution isotropic imaging, CBBCT has the potential to usher in a new era in breast imaging. These advantages could translate into lower morbidity and mortality from breast cancer.

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Topics: Breast imaging (76%), Diagnostic Mammography (69%), Mammography (68%) ... show more

Open accessJournal ArticleDOI: 10.1016/J.EJRAD.2021.109883
Abstract: In women with newly diagnosed breast cancer, preoperative staging is required to assess disease extent, enabling us to decide on the most optimal treatment strategy. For locoregional staging, assessment of intramammary tumor extent and presence of axillary and perhaps also internal mammary lymph node metastases is required. Due to the similarity in the underlying principle, contrast-enhanced mammography is increasingly considered instead of breast MRI for this purpose. When considering the combination of CEM and US as a single appointment imaging strategy for preoperative staging of breast cancer, there is only limited room for an additional benefit of breast MRI. For tumor size measurements, equal performance of both CEM and MRI are observed. Sensitivity of both techniques for detecting breast cancer is comparable, meaning that both techniques are capable of detecting additional ipsilateral or contralateral tumor foci. However, specificity is in favor of CEM, meaning that there is a slightly lower chance of having false positive findings in preoperative staging of the breast. Axillary US can be performed during the same appointment as CEM, with equal performance and limitations as evaluation of the axilla on standard breast MRI examinations. Finally, there is no need to actively pursue the detection of IMLN metastases, meaning that additional MRI to do so is not required. This review provides a 'pro-CEM' perceptive on the arguments why breast MRI is hardly necessary when CEM in combination with US has been performed as a single appointment imaging strategy in breast cancer patients.

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Topics: Breast MRI (71%), Breast cancer (60%), Mammography (57%) ... show more

Open accessJournal ArticleDOI: 10.1259/BJRO.20210034
31 Aug 2021-
Abstract: Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protoc...

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Topics: Mammography (61%), Iodinated contrast (57%), Breast imaging (54%)

References
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55 results found


Open accessJournal ArticleDOI: 10.3322/CANJCLIN.57.2.75
Debbie Saslow1, Carla Boetes, Wylie Burke2, Steven E. Harms3  +11 moreInstitutions (12)
Abstract: New evidence on breast Magnetic Resonance Imaging (MRI) screening has become available since the American Cancer Society (ACS) last issued guidelines for the early detection of breast cancer in 2003. A guideline panel has reviewed this evidence and developed new recommendations for women at different defined levels of risk. Screening MRI is recommended for women with an approximately 20-25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer and women who were treated for Hodgkin disease. There are several risk subgroups for which the available data are insufficient to recommend for or against screening, including women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography. Diagnostic uses of MRI were not considered to be within the scope of this review.

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Topics: Breast MRI (71%), Breast cancer (67%), Mammography (62%) ... show more

2,132 Citations


Journal ArticleDOI: 10.7326/0003-4819-138-3-200302040-00008
Abstract: Mammographic breast density and age are important predictors of the accuracy of screening mammography. Although use of hormone replacement therapy is not an independent predictor of accuracy, it pr...

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Topics: Mammography (61%), Breast cancer (59%), Transgender hormone therapy (55%) ... show more

1,035 Citations


Journal ArticleDOI: 10.1148/RADIOL.2442051620
Christiane K. Kuhl1Institutions (1)
01 Aug 2007-Radiology
Abstract: Compared with mammography and breast ultrasonography, contrast material–enhanced magnetic resonance (MR) imaging is a breast imaging technique that offers not only information on lesion cross-sectional morphology but also on functional lesion features such as tissue perfusion and enhancement kinetics. After an enthusiastic start to clinical breast MR imaging in the early 1990s, a variety of difficulties and obstacles were identified that hampered the transfer of the modality into clinical practice, including a lack of standardization regarding image acquisition and interpretation guidelines, a lack of MR-compatible interventional materials, and a lack of evidence regarding its diagnostic accuracy—particularly specificity and positive predictive value, as well as sensitivity for ductal carcinoma in situ. This article is the first of two on the current status of breast MR imaging. The pathophysiologic basis of breast MR and the effects on acquisition technique and diagnostic accuracy, the diverging demands ...

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Topics: Breast imaging (66%), Mammography (56%)

685 Citations


Journal ArticleDOI: 10.2214/AJR.181.5.1811275
Abstract: OBJECTIVE. This study was undertaken to evaluate the ability of MRI to accurately show residual primary breast malignancy in women treated with neoadjuvant chemotherapy.MATERIALS AND METHODS. Twenty-one patients with locally advanced primary breast carcinoma underwent contrast-enhanced MRI before and after treatment with neoadjuvant anthracycline-based chemotherapy. For each patient, the maximum extent of the MRI abnormality was measured both before and after treatment. These measurements were subsequently compared with physical examination findings and histologic results to determine the ability of MRI to accurately reveal tumor extent after neoadjuvant chemotherapy.RESULTS. MRI after chemotherapy showed a correlation coefficient of 0.75 with histology, which was better than physical examination (r = 0.61). MRI underestimated the extent of residual tumor in two patients by more than 1 cm (including one false-negative examination), was within 1 cm in 12 of 21 patients, and overestimated tumor extent by mo...

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Topics: Breast cancer (53%)

257 Citations


Open accessJournal ArticleDOI: 10.1148/RADIOL.12121084
01 Mar 2013-Radiology
Abstract: Bilateral dual-energy contrast-enhanced digital mammography was feasible, easily accomplished, and depicted known primary tumors at a rate comparable to that of MR imaging and higher than that of conventional digital mammography.

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247 Citations


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