Contrast-enhanced mammography: what the radiologist needs to know
31 Aug 2021-Vol. 3, Iss: 1, pp 20210034
TL;DR: This comprehensive review provides a practical overview of C EM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of Cem; and future developments.
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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TL;DR: In this paper , the authors evaluated the potential of contrastenhanced mammography (CEM) for reducing the biopsy rate of screening recalls, and compared the McNemar's test with recombined CEM.
Abstract: To evaluate the potential of contrast-enhanced mammography (CEM) for reducing the biopsy rate of screening recalls.Recalled women were prospectively enrolled to undergo CEM alongside standard assessment (SA) through additional views, tomosynthesis, and/or ultrasound. Exclusion criteria were symptoms, implants, allergy to contrast agents, renal failure, and pregnancy. SA and CEM were independently evaluated by one of six radiologists, who recommended biopsy or 2-year follow-up. Biopsy rates according to SA or recombined CEM (rCEM) were compared with the McNemar's test. Diagnostic performance was calculated considering lesions with available final histopathology.Between January 2019 and July 2021, 220 women were enrolled, 207 of them (median age 56.6 years) with 225 suspicious findings analysed. Three of 207 patients (1.4%) developed mild self-limiting adverse reactions to iodinated contrast agent. Overall, 135/225 findings were referred for biopsy, 90/225 by both SA and rCEM, 41/225 by SA alone and 4/225 by rCEM alone (2/4 being one DCIS and one invasive carcinoma). The rCEM biopsy rate (94/225, 41.8%, 95% CI 35.5-48.3%) was 16.4% lower (p < 0.001) than the SA biopsy rate (131/225, 58.2%, 95% CI 51.7-64.5%). Considering the 124/135 biopsies with final histopathology (44 benign, 80 malignant), rCEM showed a 93.8% sensitivity (95% CI 86.2-97.3%) and a 65.9% specificity (95% CI 51.1-78.1%), all 5 false negatives being ductal carcinoma in situ detectable as suspicious calcifications on low-energy images.Compared to SA, the rCEM-based work-up would have avoided biopsy for 37/225 (16.4%) suspicious findings. Including low-energy images in interpretation provided optimal overall CEM sensitivity.• The work-up of suspicious findings detected at mammographic breast cancer screening still leads to a high rate of unnecessary biopsies, involving between 2 and 6% of screened women. • In 207 recalled women with 225 suspicious findings, recombined images of contrast-enhanced mammography (CEM) showed a 93.8% sensitivity and a 65.9% specificity, all 5 false negatives being ductal carcinoma in situ detectable on low-energy images as suspicious calcifications. • CEM could represent an easily available one-stop shop option for the morphofunctional assessment of screening recalls, potentially reducing the biopsy rate by 16.4%.
9 citations
TL;DR: In this article , the diagnostic accuracy of contrast-enhanced mammography (CEM) compared to standard contrastenhanced breast magnetic resonance imaging (breast MRI) was evaluated.
Abstract: Background: To provide a systematic review and meta-analysis that evaluates the diagnostic accuracy of contrast-enhanced mammography (CEM) compared to standard contrast-enhanced breast magnetic resonance imaging (breast MRI). Like breast MRI, CEM enables tumour visualization by contrast accumulation. CEM seems to be a viable substitute for breast MRI. Methods: This systematic search assessed the diagnostic accuracy of these techniques in women with suspicious breast lesions on prior imaging or physical examination, who have undergone both breast MRI and CEM. CEM had to be performed on a commercially available system. The MRI sequence parameters had to be described sufficiently to ensure that standard breast MRI sequence protocols were used. Pooled values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR), were estimated using bivariate mixed-effects logistic regression modeling. Hierarchical summary receiver operating characteristic curves for CEM and breast MRI were also constructed. Results: Six studies (607 patients with 775 lesions) met the predefined inclusion criteria. Pooled sensitivity was 96% for CEM and 97% for breast MRI. Pooled specificity was 77% for both modalities. DOR was 79.5 for CEM and 122.9 for breast MRI. Between-study heterogeneity expressed as the I2-index was substantial with values over 80%. Conclusion: Pooled sensitivity was high for both CEM and breast MRI, with moderate specificity. The pooled DOR estimates, however, indicate higher overall diagnostic performance of breast MRI compared to CEM. Nonetheless, current scientific evidence is too limited to prematurely discard CEM as an alternative for breast MRI.
6 citations
30 Nov 2022
TL;DR: In this paper , the authors explore the factors hindering the clinical implementation of contrastenhanced mammography (CEM) and highlight the potential benefits of using CEM in clinical applications.
Abstract: Accumulating evidence shows that contrast-enhanced mammography (CEM) has higher diagnostic performance than digital mammography and ultrasound, and comparable diagnostic performance as MRI, for various indications. CEM also offers certain practical advantages for patients. Nevertheless, the clinical implementation of CEM has been limited due to a range of factors. This AJR Expert Panel Narrative Review explores such factors hindering CEM implementation. These include: risks of iodinated contrast media, increased radiation exposure, indications for which CEM is not the preferred test or for which further evidence is needed, workflow adjustments when performing CEM examinations, incomplete availability of CEM-guided biopsy systems, and reimbursement challenges. Considerations that currently or are expected to mitigate these factors are also highlighted.
2 citations
TL;DR: In this article , a new feature of enhancement, "Lesion Conspicuity", demonstrated satisfactory performance in predicting the malignancy of lesions and significant correlation with the receptor profile of malignant breast neoplasms.
1 citations
17 Nov 2022
TL;DR: In this paper , the authors used a model of a compressed breast made from clear resin with holes on the top and filled the holes with iodine-based contrast and images with six different energies were obtained at a general purpose x-ray unit.
Abstract: Dual energy contrast-enhanced spectral mammography (CESM) technique has been introduced to overcome the standard mammography's performance on dense breasts. To enhance the visualization of the tumour, iodine contrast is used followed by an acquisition of images at low and high energies, which are then combined into a single image for additional information. This study used a model of a compressed breast made from clear resin with holes on the top. The holes were filled with iodine-based contrast and images with six different energies (50 kVp, 70 kVp, 80 kVp, 90 kVp, 100 kVp, 120 kVp) were obtained at a general purpose x-ray unit. Then, 15 subtraction images were calculated by performing a pixel by pixel subtraction of each possible image pair and the contrast was evaluated. The results indicated that the best contrast rates are achieved on 50 kVp and 70 kVp as low energy and 100 kVp and 120 kVp as high energy. The best contrast was evaluated for the pair 70–120 kVp.
References
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Book•
23 Mar 2006
TL;DR: Health risks from exposure to low levels of ionizing radiation : BEIR VII Phase 2 , Health risks from Exposure to low Levels of Ionizing radiation: BEIR VIII Phase 2, شاپور اهواز.
Abstract: Health risks from exposure to low levels of ionizing radiation : BEIR VII Phase 2 , Health risks from exposure to low levels of ionizing radiation : BEIR VII Phase 2 , کتابخانه دیجیتال جندی شاپور اهواز
2,416 citations
TL;DR: Extensive mammographic density is strongly associated with the risk of breast cancer detected by screening or between screening tests, and a substantial fraction of breast cancers can be attributed to this risk factor.
Abstract: Methods We carried out three nested case–control studies in screened populations with 1112 matched case–control pairs. We examined the association of the measured percentage of density in the baseline mammogram with risk of breast cancer, according to method of cancer detection, time since the initiation of screening, and age. Results As compared with women with density in less than 10% of the mammogram, women with density in 75% or more had an increased risk of breast cancer (odds ratio, 4.7; 95% confidence interval [CI], 3.0 to 7.4), whether detected by screening (odds ratio, 3.5; 95% CI, 2.0 to 6.2) or less than 12 months after a negative screening examination (odds ratio, 17.8; 95% CI, 4.8 to 65.9). Increased risk of breast cancer, whether detected by screening or other means, persisted for at least 8 years after study entry and was greater in younger than in older women. For women younger than the median age of 56 years, 26% of all breast cancers and 50% of cancers detected less than 12 months after a negative screening test were attributable to density in 50% or more of the mammogram. Conclusions Extensive mammographic density is strongly associated with the risk of breast cancer detected by screening or between screening tests. A substantial fraction of breast cancers can be attributed to this risk factor.
2,012 citations
TL;DR: Results indicate that the dual-energy contrast agent-enhanced digital subtraction mammography technique is feasible and worthy of further study.
Abstract: A technique for demonstrating breast cancers, dual-energy contrast agent–enhanced digital subtraction mammography, was performed in 26 subjects with mammographic or clinical findings that warranted biopsy. The technique consists of high-energy and low-energy digital mammography after administration of iodinated contrast agent. Weighted subtraction of the logarithmic transform of these images is then performed to obtain an image that preferentially shows iodine. Of the 26 subjects, 13 had invasive cancers. Eleven of these tumors enhanced strongly, one enhanced moderately, and one enhanced weakly. The duct in one patient with ductal carcinoma in situ was weakly enhancing. In the other 12 patients, benign tissue enhanced diffusely in two and weakly focally in two. These results indicate that the technique is feasible and worthy of further study. © RSNA, 2003
382 citations
TL;DR: MRI of the breast has the highest sensitivity for breast cancer detection among current clinical imaging modalities and is indispensable for breast imaging practice, and in experienced hands this can be used to improve breast cancer surgery, although there is no evidence of improved long-term outcomes.
Abstract: MRI of the breast has the highest sensitivity for breast cancer detection among current clinical imaging modalities and is indispensable for breast imaging practice. While the basis of breast MRI consists of T1-weighted contrast-enhanced imaging, T2-weighted, ultrafast, and diffusion-weighted imaging may be used to improve lesion characterization. Such multiparametric assessment of breast lesions allows for excellent discrimination between benign and malignant breast lesions. Indications for breast MRI are expanding. In preoperative staging, multiple studies confirm the superiority of MRI to other imaging modalities for tumor size estimation and detection of additional tumor foci in the ipsilateral and contralateral breast. Ongoing studies show that in experienced hands this can be used to improve breast cancer surgery, although there is no evidence of improved long-term outcomes. Screening indications are likewise growing as evidence is accumulating that OncologicRI depicts cancers at an earlier stage than mammography in all women. To manage the associated costs for screening, the use of abbreviated protocols may be beneficial. In patients treated with neoadjuvant chemotherapy, MRI is used to document response. It is essential to realize that oncologic and surgical response are different, and evaluation should be adapted to the underlying question.
343 citations
TL;DR: Bilateral dual-energy contrast agent-enhanced digital mammography was feasible and easily accomplished and was used to detect known primary tumors at a rate comparable to that of MR imaging and higher than that of conventionaldigital mammography.
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.
308 citations