Diagnostic accuracy of screening contrast-enhanced mammography for women with extremely dense breasts at increased risk of breast cancer Journal Article
| Authors: | Nissan, N.; Comstock, C. E.; Sevilimedu, V.; Gluskin, J.; Mango, V. L.; Hughes, M.; Ochoa-Albiztegui, R. E.; Sung, J. S.; Jochelson, M. S. |
| Article Title: | Diagnostic accuracy of screening contrast-enhanced mammography for women with extremely dense breasts at increased risk of breast cancer |
| Abstract: | Background: Mammogram interpretation is challenging in female patients with extremely dense breasts (Breast Imaging Reporting and Data System [BI-RADS] category D), who have a higher breast cancer risk. Contrast-enhanced mammography (CEM) has recently emerged as a potential alternative; however, data regarding CEM utility in this subpopulation are limited. Purpose: To evaluate the diagnostic performance of CEM for breast cancer screening in female patients with extremely dense breasts. Materials and Methods: This retrospective single-institution study included consecutive CEM examinations in asymptomatic female patients with extremely dense breasts performed from December 2012 to March 2022. From CEM examinations, low-energy (LE) images were the equivalent of a two-dimensional full-field digital mammogram. Recombined images highlighting areas of contrast enhancement were constructed using a postprocessing algorithm. The sensitivity and specificity of LE images and CEM images (ie, including both LE and recombined images) were calculated and compared using the McNemar test. Results: This study included 1299 screening CEM examinations (609 female patients; mean age, 50 years ± 9 [SD]). Sixteen screen-detected cancers were diagnosed, and two interval cancers occured. Five cancers were depicted at LE imaging and an additional 11 cancers were depicted at CEM (incremental cancer detection rate, 8.7 cancers per 1000 examinations). CEM sensitivity was 88.9% (16 of 18; 95% CI: 65.3, 98.6), which was higher than the LE examination sensitivity of 27.8% (five of 18; 95% CI: 9.7, 53.5) (P = .003). However, there was decreased CEM specificity (88.9%; 1108 of 1246; 95% CI: 87.0, 90.6) compared with LE imaging (specificity, 96.2%; 1199 of 1246; 95% CI: 95.0, 97.2) (P < .001). Compared with specificity at baseline, CEM specificity at follow-up improved to 90.7% (705 of 777; 95% CI: 88.5, 92.7; P = .01). Conclusion: Compared with LE imaging, CEM showed higher sensitivity but lower specificity in female patients with extremely dense breasts, although specificity improved at follow-up. © RSNA, 2024. |
| Keywords: | adult; aged; middle aged; retrospective studies; sensitivity and specificity; breast; diagnostic imaging; breast neoplasms; retrospective study; mammography; image enhancement; breast tumor; contrast medium; contrast media; early detection of cancer; radiographic image enhancement; breast density; procedures; humans; human; female; early cancer diagnosis |
| Journal Title: | Radiology |
| Volume: | 313 |
| Issue: | 1 |
| ISSN: | 0033-8419 |
| Publisher: | Radiological Society of North America, Inc. |
| Date Published: | 2024-10-01 |
| Start Page: | e232580 |
| Language: | English |
| DOI: | 10.1148/radiol.232580 |
| PUBMED: | 39352285 |
| PROVIDER: | scopus |
| PMCID: | PMC11535862 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author Maxine S. Jochelson -- Source: Scopus |
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