European Radiology: The value of contrast-enhanced mammography for routine breast screening in women

Clinically, although the benefits of mammography screening outweigh the harms, the entire screening process can create various problems, of which false alarm recall is one of the most important
。 Currently, the most commonly used evaluation modalities – such as additional mammography, digital mammography, and ultrasound – rely entirely on morphological evaluation
of suspicious findings.
Conversely, imaging techniques that provide morphological and functional information reduce the biopsy rate, i.
e.
, increase the positive predictive value (PPV)
of the examination.

In morphologically functional mammography, contrast-enhanced mammography (CEM) may be more appropriate than contrast-enhanced mammography (CE-MRI) for screening for detected suspicious findings
。 The potential of CEM has also been highlighted in a recent meta-analysis, with CEM having a sensitivity of 92% and specificity of 84% when applied to suspicious findings detected by mammography
.

Recently, a study published in the journal European Radiology evaluated the ability of CEM to reduce the rate of breast biopsies in women with abnormal mammography screening, which provides technical support
for further optimizing the breast screening process and reducing unnecessary biopsies.

This review evaluated recalled mammography screening women at our facility and collected additional mammography views, tomography, and/or ultrasonography from patients , each patient prospectively underwent CEM and standard assessment (SA).

Exclusion criteria were clinical symptoms, presence of implants, allergy to contrast, renal failure, and pregnancy
.
SA and CEM were independently evaluated by one of six radiologists, who recommended a biopsy or 2-year follow-up
.
Biopsy rates based on SA or recombinant CEM (rCEM) are compared
to McNemar's test.

Between January 2019 and July 2021, a total of 220 women were recruited and 225 suspicious outcomes were analyzed for 207 of them (median age 56.
6 years).

Three of 207 patients (1.
4%) had mild self-limited adverse effects
on iodine contrast.
Overall, 135/225 results were referred for biopsy, with both SA and rCEM being 90/225, SA alone being 41/225, and rCEM alone being 4/225 (2/4 being 1 DCIS and 1 invasive carcinoma).

。 The rCEM biopsy rate (94/225, 41.
8%, 95% CI 35.
5-48.
3%) was 16.
4% (p < 0.
001)
lower than the SA biopsy rate (131/225, 58.
2%, 95% CI 51.
7-64.
5%).
By comparing final histopathological biopsy findings (44 benign, 80 malignant), rCEM showed 93.
8% sensitivity (95% CI 86.
2-97.
3%) and 65.
9% specificity (95% CI 51.
1-78.
1%)
。

Figure comparison of true negative cases
on enhanced mammography.
A 58-year-old woman is recalled for suspected retroareolar irregularities in her right breast (figures A and C, light blue rectangle).

An ultrasound-guided core needle biopsy was performed, and the diagnosis was hyperhidrine metaplasia
.
The lack of enhanced focus on reconstituted images (Figures B and D) will lead to referral to follow-up

This study showed that assessment of rCEM-based women at primary screening was able to reduce biopsy rates by 16.
4% while maintaining high sensitivity (93.
8%), with false-negatives representing DCIS
that can only be clearly detected on low-energy CEM images.
The data presented in this study further highlight the role of CEM in assessing suspicious abnormalities found on mammography and avoiding the large
number of unnecessary biopsies.

Original source:

Andrea Cozzi,Simone Schiaffino,Marianna Fanizza,et al.
Contrast-enhanced mammography for the assessment of screening recalls: a two-centre study.
DOI:10.
1007/s00330-022-08868-3