Contrast-enhanced mammography significantly improves early cancer detection
Contrast-enhanced mammography (CEM) may offer a viable alternative to breast MRI for women with dense breast tissue who require supplemental imaging beyond standard digital breast tomosynthesis (DBT).
New data published this week in the journal Radiology detail the findings of an active clinical trial assessing the use of CEM in lieu of breast MRIs in women with dense breasts. The study’s findings suggest that CEM could significantly enhance breast cancer detection beyond DBT when patients are faced with barriers to obtaining an MRI—the modality that has yielded the most promising results thus far as a supplemental exam for women with dense breasts.
“Relative to the number of women who may benefit from screening MRI, there is a shortage of equipment/capacity,” principal investigator Wendie Berg, MD, PhD, professor of radiology at University of Pittsburgh School of Medicine, and colleagues explained. “Further, nearly half of women cannot have an MRI for medical or other reasons, such as claustrophobia, implanted devices, body habitus, or cost (deductible and copay apply even with the new legislation). Contrast-enhanced mammography appears to have similar performance to MRI but has not been widely validated, particularly for screening.”
For the study, researchers had a group of 601 women who had already undergone DBT and were eligible for breast MRI complete a CEM exam. Two readers interpreted the mammograms, with one reading DBT exams first and the other starting with CEM.
The team compared the incremental cancer detection rate, false-positive rate due to recall, positive predictive value of biopsies performed and areas under receiver operating characteristic curve between the two exams.
Of the 601 women who underwent CEM, 12 were diagnosed with 16 malignant lesions. Five of those participants’ lesions were detected on DBT by the reader who started with DBT, while one was identified on DBT by the reader who started with CEM. Cancers for the other six women were caught on CEM only, five of which had invasive disease, all node negative, with a median lesion size of 0.7 cm, while three were lobular.
The combination of DBT and CEM increased the false-positive rate by 13.4% for the first reader compared to the use of DBT alone. However, DBT plus CEM increased the reader’s area under receiver operating characteristic curve from 0.73 to .92, indicating CEM could be a viable alternative to MRI in terms of performance.
“A significant increase in the detection of early-stage breast cancer was achieved using CEM after DBT. Despite substantially increasing the [false-positive rate], adding CEM to DBT improved the overall AUC by 0.19,” the group noted.
Learn more about the team’s findings thus far here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.