Role of contrast-enhanced digital mammography in evaluation of breast lesions

Abstract

Objective The purpose of this study was to assess the role of dual-energy contrast mammography (MX) in evaluating breast lesions. Background Contrast-enhanced digital mammography (CEDM) can significantly improve diagnostic quality such as clarification of mammographic and sonographic equivocal lesions, detection of occult lesions on MX, determination of the extent of disease, and assessment of recurrent disease. Patients and methods A total of 50 female patients were enrolled into the present study, with their ages ranging from 22 to 77 years (mean age of about 49.5), during the period between 2012 and 2014. All of them presented with benign or malignant breast lesions detected by sonomammography, categorized as Breast Imaging Reporting and Data System from 2 to 5. All were subjected to CEDM, and the images were obtained by a modified full-field digital MX system. The nonionic iodinated contrast agent was administered into the contralateral antecubital vein manually. The results were compared with the sonomammography results, and cases were histopathologically proven. Results In our study, 37/50 cases were histopathologically proven as malignant and 16/50 were benign, whereas three patients had double pathology. Different patterns of enhancement were depicted on contrast-enhanced digital mammography (CEDM) in all histologically proven breast carcinomas. Our results show that sensitivity was higher for MX + CEDM (83.3%) compared with pathology and Breast Imaging Reporting and Data System analysis, respectively, with no loss in specificity. Compared with MX associated with breast ultrasound, CEDM had a better diagnostic accuracy mainly because of improved specificity and better positive and negative predictive values (positive predictive value and negative predictive value were 86 and 64.7%, respectively). Conclusion The addition of dual energy contrast-enhanced MX technique to conventional sonomammography can significantly improve diagnostic quality and cancer detection rate.