The diagnostic value of contrast-enhanced 2D mammography in everyday clinical use

L M F H Neeter,S M E C Timmermans,K M Duvivier,S D Meens-Koreman,R S A Van Stiphout,H P J Raat,P J Nelemans,M L Smidt,M B I Lobbes,J E Wildberger

doi:10.1038/s41598-021-01622-7

L M F H Neeter, S M E C Timmermans + Show 8 more

Open Access

https://doi.org/10.1038/s41598-021-01622-7

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Abstract

Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.

Highlights

Contrast-enhanced mammography (CEM) is an emerging breast imaging modality in which the intravenous administration of an iodine based contrast agent, combined with dual-energy mammography, is used to increase the diagnostic accuracy of full-field digital mammography (FFDM)
Many studies have shown that CEM’s diagnostic accuracy is superior to FFDM, even matching the performance of breast MRI16–19. These results are mainly based on studies performed on GE Healthcare systems
Several reviews and meta-analyses have been p ublished[5,6,20], we believe that the one published by Zhu et al is the most comprehensive one

Summary

Introduction

Contrast-enhanced mammography (CEM) is an emerging breast imaging modality in which the intravenous administration of an iodine based contrast agent, combined with dual-energy mammography, is used to increase the diagnostic accuracy of full-field digital mammography (FFDM). Studies have shown that CEM is consistently superior to FFDM in terms of diagnostic accuracy, especially in women with dense breasts[3]. Due to this increased diagnostic accuracy, it is even being considered for screening purposes[4]. In a review by Zhu et al, including 18 studies, the pooled sensitivity and specificity of CEM was 0.89. It is unethical to have women undergo more than one CEM exam solely for this research purpose

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