Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery.

Jill Gluskin,Melissa Pilewskie,Carolina Rossi Saccarelli,Almir G V Bitencourt,Janice S Sung,Maria Adele Marino,Maxine S Jochelson,Varadan Sevilimedu,Daly Avendano,Katja Pinker

doi:10.3390/cancers12123495

Abstract

Simple SummaryBreast cancer survivors are at risk for recurrence, and the early detection of recurrence improves survival. Therefore, imaging surveillance is performed for women who have breast-conserving surgery. The aim of our retrospective study was to compare routine mammography with contrast-enhanced mammography in the screening (asymptomatic) post-treatment setting. We confirmed that when screening women with breast conservation surgery, contrast-enhanced mammography had a higher cancer detection rate (15.4/1000) and positive predictive value of biopsies (42.9%) than full-field digital mammography (6.2/1000 and 37.5%, respectively).To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM.

Highlights

Survival from breast cancer has improved over the past three decades, with the death rate dropping by 39% from 1989 to 2015, resulting in a growing population of survivors at risk for local recurrence or second primary breast cancer
A portion of this patient cohort has been previously reported in three studies with a different research aim from the present study: 48 women were previously reported in a study comparing background parenchymal enhancement at contrast-enhanced mammography (CEM) and breast magnetic resonance imaging (MRI) [34], 61 patients were previously reported in a pilot study comparing CEM and MRI for women at an increased risk for breast cancer [28], and 250 patients were previously reported in a study comparing CEM and low-energy images in screening women at an increased risk of breast cancer [23]
A diagnostic breast MRI was prompted by 48/971 (4.9%) exams, which were considered a positive result for the statistical analysis, as MRI was performed for a potential biopsy

Summary

Introduction

Survival from breast cancer has improved over the past three decades, with the death rate dropping by 39% from 1989 to 2015, resulting in a growing population of survivors at risk for local recurrence or second primary breast cancer. A meta-analysis of 13 retrospective studies involving 2263 patients demonstrated an improvement in survival when breast cancer recurrence was detected on a mammography when asymptomatic rather than when detected in a physical examination or when there are other symptoms [8]. In another retrospective study of 1044 women, the early detection of asymptomatic breast cancer recurrence improved survival by 27−47% compared with symptomatic recurrence [9]. While early detection is crucial for improved survival, a mammography may be less sensitive in the post-surgical breast compared to the non-treated breast, given that post-treatment changes (including fat necrosis, surgical distortion, metallic clips, and scars) can obscure cancers on screening mammography [10,11,12]

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