Performance of dual-energy contrast-enhanced digital mammography for screening women at increased risk of breast cancer Journal Article


Authors: Sung, J. S.; Lebron, L.; Keating, D.; D'Alessio, D.; Comstock, C. E.; Lee, C. H.; Pike, M. C.; Ayhan, M.; Moskowitz, C. S.; Morris, E. A.; Jochelson, M. S.
Article Title: Performance of dual-energy contrast-enhanced digital mammography for screening women at increased risk of breast cancer
Abstract: Background: Contrast agent-enhanced digital mammography (CEDM) has been shown to be more sensitive and specific than twodimensional full-field digital mammography in the diagnostic setting. Few studies have reported on its performance in the screening setting. Purpose: To evaluate the performance of CEDM for breast cancer screening. Materials and Methods: This retrospective study included women who underwent dual-energy CEDM for breast cancer screening from December 2012 through April 2016. Medical records were reviewed for age, risk factors, short-interval follow-up and biopsies recommended, and cancers detected. Sensitivity, specificity, positive predictive value of abnormal findings at screening (PPV1), positive predictive value of biopsy performed (PPV3), and negative predictive value were determined. Results: In the study period 904 baseline CEDMs were performed. Mean age was 51.8 years 6 9.4 (standard deviation). Of 904 patients, 700 (77.4%) had dense breasts, 247 (27.3%) had a family history of breast cancer in a first-degree relative age 50 years or younger, and 363 (40.2%) a personal history of breast cancer. The final Breast Imaging Reporting and Data System score was 1 or 2 in 832 of 904 (92.0%) patients, score of 3 in 25 of 904 (2.8%) patients, and score of 4 or 5 in 47 of 904 (5.2%) patients. By using CEDM, 15 cancers were diagnosed in 14 of 904 women (cancer detection rate, 15.5 of 1000). PPV3 was 29.4% (15 of 51). At least 1-year follow up was available in 858 women. There were two interval cancers. Sensitivity was 50.0% (eight of 16; 95% confidence interval [CI]: 24.7%, 75.3%) on the low-energy images compared with 87.5% (14 of 16; 95% CI: 61.7%, 98.4%) for the entire study (low-energy and iodine images; P = .03). Specificity was 93.7% (789 of 842; 95% CI: 91.8%, 95.2%); PPV1 was 20.9% (14 of 67; 95% CI: 11.9%, 32.6%), and negative predictive value was 99.7% (789 of 791; 95% CI: 99.09%, 99.97%). Conclusion: Contrast-enhanced digital mammography is a promising technique for screening women with higher-than-average risk for breast cancer. © RSNA, 2019.
Journal Title: Radiology
Volume: 293
Issue: 1
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2019-10-01
Start Page: 81
End Page: 88
Language: English
DOI: 10.1148/radiol.2019182660
PUBMED: 31453765
PROVIDER: scopus
PMCID: PMC6776233
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Janice Sinae Sung
    49 Sung
  2. Carol Lee
    22 Lee
  3. Malcolm Pike
    165 Pike
  4. Delia M Keating
    13 Keating
  5. Elizabeth A Morris
    327 Morris
  6. Chaya S. Moskowitz
    223 Moskowitz
  7. Miranda Shireen Ayhan
    1 Ayhan