4 uses for contrast-enhanced spectral mammography
Researchers and clinicians from Cooper University Hospital have been using spectral mammography on a daily basis since November 2012. A group from Cooper published a review of techniques and practical applications of contrast-enhanced spectral mammography (CESM) in Academic Radiology.
Contrast-enhanced spectral mammography (CESM) combines digital mammography with the benefits of contrast imaging, using the high rates of blood vessel formation in tumors to distinguish between cancerous and healthy tissue. While it approaches MRI’s sensitivity, CESM lacks MRI’s high rate of false-positives that can result in unnecessary studies or biopsies. It’s also much quicker than MRI; results are available to be immediately reviewed with the patient, potentially alleviating the stresses that accompany any cancer screening.
In addition, CESM dosage falls well below the guidelines set forth by the American College of Radiology, maxing out at 50 percent of the recommended dose. While researchers were careful to note the difficulties in imaging small masses or masses near the chest wall, CESM excels in a number of clinical applications.
1. High-risk screening
Because of its sensitivity and specificity, CESM lends itself to screening high-risk patients, including those with BRCA1 or BRCA2 mutations, a family history of ovarian or breast cancer or a close relatively with breast cancer before 50.
2. Diagnostic workup
CESM works well for a general diagnostic workup—especially when examining possible bilateral abnormalities, as both breasts can be imaged simultaneously. In addition, CESM offers improvements in sensitivity when imaging dense breasts or breasts with dense parenchyma.
3. Cancer staging
CESM can replace MRI in cancer staging, most notably in patients who have difficulty with MRI due to implanted medical devices or claustrophobia. While there are minor limitations, CESM is outperforms MRI in cancer staging with less background enhancement, according to the authors.
4. Response to neoadjuvant chemotherapy
Spectral mammography can be used to monitor a patient’s response to chemotherapy administered before surgical resection. It’s most often used in patients who can’t or won’t undergo an MRI.