Constance "Connie" Lehman, MD, PhD, chief of breast imaging, co-director of the Avon Comprehensive Breast Evaluation Center at the Massachusetts General Hospital, and professor of radiology at Harvard Medical School, discusses the pros vs. cons of supplemental breast imaging, including breast ultrasound, breast MRI and contrast-enhanced mammography. Of these, Lehman said contrast-enhanced mammography might become the easiest to access and use. It also enables vascular imaging, so like MRI, it can show areas of dense vascular growths that are generally associated with cancer. She said the technology holds a lot of promise because it can be used with existing mammography systems, but the technology needs to show its efficacy evidence in clinical trials.
"I am a huge fan of ultrasound and use it everyday in practice. And automated breast ultrasound is a technology that has really helped expand access to high-quality breast ultrasound for women of diverse geographies, including rural areas where they might not have access to a highly qualified sonographer," Lehman explained. "But, I have to say after reviewing the literature on screening ultrasound, I am just not sure it checks all the boxes that we need for supplemental imaging."
An increased numbers of cancers can be found using breast ultrasound that were not identified through mammography in women with dense breasts. However, it is a relatively small number of additional cancers. Adding in breast MRI or vascular imaging can lead to a huge leap in finding new cancers. Vascular imaging of the breast can be performed with both MRI and contrast-enhanced mammography.
"I would say if you have a patient who is at risk for having a cancer missed on mammography, look to vascular imaging and MRI," Lehman explained. "But we also know MRI is rife with problems. Patients are uncomfortable with the MRI, it is costly [and] we don't have access to high-quality breast MRI in all regions. And that is why I think the future is so bright for contrast-enhanced mammography."
Existing mammography systems can be upgraded to perform contrast mammo exams, so she believed this will help off set issues with access to MRI. It also can be performed at the same imaging center where patients get their breast screenings, so it does not require scheduling additional appointments at other locations.
"I believe from the early data from the first studies that have come out, that contrast-enhanced mammography is going to perform very well compared to contrast enhanced MRI at a fraction of the cost," Lehman said. "It also would be a significant bump up for women having access to the technology."
There are currently reimbursement issues with contrast-enhanced mammography, but she said with additional clinical evidence, this will change over time.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com