Study: Contrast-Enhanced Mammography Changes Surgical Plan in 22.5 Percent of Breast Cancer Cases

Emerging research suggests that contrast-enhanced mammography (CEM) can play a significant role in pre-op staging for women with breast cancer.

For the retrospective study, presented at the recent Radiological Society of North America (RSNA) conference, researchers reviewed data from 524 CEM exams (for 525 malignant lesions) performed over a three-year period from 2017 to 2020.

Utilization of CEM helped diagnose additional breast lesions in 226 patients (43 percent) in the study cohort, according to the study authors. Out of 96 additional biopsies (18.2 percent) triggered by CEM findings, the researchers noted that 52 percent revealed malignant lesions.¹

The study authors emphasized that preoperative use of CEM led to changes in surgical management in 118 cases (22.5 percent). For 64 patients (12.2 percent), an initial plan of breast-conserving surgery (BCS) was changed to a mastectomy procedure, according to the researchers. They also found that 33 patients (6.3 percent) required more extensive BCS, and 18 women (3.4 percent) needed surgery on the contralateral breast.¹

The use of contrast-enhanced mammography in the above case led to a diagnosis of invasive carcinoma of the axillary tail of the right breast in a 59-year-old patient. (Images courtesy of RSNA.)

“It is also important to state that no conversions to mastectomy were made on the basis of a false positive finding on CEM in our study,” noted Chiara Bellini, MD, a breast radiologist affiliated with the Careggi University Hospital in Florence, Italy.

(Editor’s note: For related content, see “Study Says Contrast-Enhanced Mammography Offers Comparable Breast Cancer Detection to MRI,” “Study Reveals Tradeoffs Between Contrast-Enhanced Mammography and MRI for Supplemental Screening” and “Does Timing of Imaging Affect Interpretation of Contrast-Enhanced Mammography?”)

For study participants with non-palpable lesions, CEM demonstrated a 92.4 percent sensitivity rate, a 95.2 percent specificity rate, an accuracy rate of 94.5 percent and an area under the curve (AUC) of 93.8 percent. The researchers noted even higher breast cancer lesion detection rates for those with palpable lesions, citing a 100 percent sensitivity rate, a 97.2 percent specificity rate, a 97.7 percent accuracy rate and a 98.6 percent AUC.¹

“Symptomatic patients with palpable lesions benefitted most from preoperative CEM with a statistically significant difference,” added Dr. Bellini.

Reference

1. Bellini C, Migliaro G. A large-scale single center evaluation of contrast enhanced mammography (CEM) in the pre-operative staging of breast cancer. Presented at the annual Radiological Society of North America (RSNA) conference, November 26-30, 2023, Chicago. Available at: https://reg.meeting.rsna.org/flow/rsna/rsna23/RSNA2023/page/post-event-attendee-portal .