Contrast-Enhanced Digital Mammography in the Surgical Management of Breast Cancer.

Abstract

Contrast-enhanced digital mammography (CEDM) is a new breast imaging technique. The role of CEDM in the surgical management of breast cancer has not yet been characterized. A retrospective review of prospective breast surgery and breast imaging databases for patients who underwent CEDM and had breast cancer surgery. A total of 351 patients had CEDM; 128 had malignant lesions, and 101 of these underwent surgery with 105 malignancies identified. The mean age was 62years (range 25-85years). The histology was 65% invasive ductal carcinoma, 16% invasive lobular carcinoma, 11% ductal carcinoma-in situ, 3% mixed invasive ductal carcinoma/invasive lobular carcinoma, and 5% other histologies. After excluding two lesions that had been removed before the examination, CEDM identified 98% (n=101/103) of the index lesions. The two lesions not identified were Paget disease only and a parasternal lesion too medial to include in the field of view. CEDM led to additional biopsies in 12% (n=12) of patients. Of these, 67% (n=8) proved to be invasive carcinoma and 33% (n=4) were benign. CEDM changed surgical management in 20% (n=20) of cancer patients with a 4% (n=4) rate of conversion to mastectomy. Among patients undergoing surgical therapy for breast cancer, CEDM was highly sensitive, had size measurements that correlated well with histologic size, and produced a relatively low rate of false-positive additional biopsy findings. CEDM appears to be promising as an alternative to magnetic resonance imaging in the surgical planning of these patients.