CESM can accurately measure small breast tumors

Scanning with contrast-enhanced spectral mammography (CESM) can detect small breast tumors and help characterize breast tissue around microcalcifications, according to a study published in the August issue of Academic Radiology.

“Preliminary results suggest a beneficial effect of CESM when differentiating benign from malignant microcalcifications of the breast,” wrote author Katrin S. Blum, MD, of the University Dusseldorf, Germany, and colleagues.

“Further research is necessary and more patients have to be investigated to prove those preliminary results,” they added.

Microcalcifications are tiny, abnormal deposits of calcium salts that are too small to be felt and can be important markers of cancer when seen on ultrasound or mammograms.

The study compared the results of CESM and ultrasound screenings to determine each modality’s accuracy in detecting and measuring the size of breast cancer tumors.

The authors said the study “demonstrates that CESM is accurate in determination of tumor size as compared to the reference standard and US although tumor size measurements with CESM may not be very precise.” They noted CESM has a lower sensitivity of detecting additional cancer compared to MRI, but a higher specificity.

The imaging was conducted by three gynecologists with five to 12 years of experience in US and by two radiologists with 15 and three years of experience, respectively, in reading mammograms and breast MRI, along with basic training in reading CESM images.

The prospective study looked at 22 women with breast cancer who were between the ages of 40 and 73. All of them had histologically proven invasive ductal and obular carcinomas.  Two women were excluded from the study because they had received chemotherapy.

A total of 13 of the women had invasive cancer with additional extensive in-situ component, while seven had invasive cancer. Four women underwent stereotactic-guided vacuum-assisted core breast biopsies within one hour after CESM.

Blum and colleagues cited a recent study that suggested CESM also could be used to screen for preoperative staging, for occult lesions, and to monitor response to cancer treatment.

Despite its potential usefulness, knowledge remains limited about CESM, which combines digital mammography with intravenous injection of iodinated contrast media to detect hypervascularized lesions, especially in dense breast tissue.

Scanning with MRI is used most frequently to determine the extent of breast cancer and the type of treatment.

However, the authors wrote, the drawbacks for MRIs include high cost, limited availability, and issues involving the background enhancement of breast tissue, thus inhibiting lesion detection.

Blum and colleagues noted that other studies found similar accuracy for CESM and MRI scans, although CESM had a lower detection rate than MRI of hypervascularized breast lesions.