Contrast-Enhanced Mammography and Dense Breasts: What a New Meta-Analysis Reveals
The 10-study meta-analysis demonstrated that contrast-enhanced mammography has a 95 percent sensitivity rate and an 81 percent specificity rate for diagnosing suspicious lesions in women with dense breasts.
Can contrast-enhanced mammography (CEM) provide a viable option for breast cancer detection in women with dense breasts?
For a new meta-analysis, recently published in Cancer Medicine, researchers reviewed data from 10 studies and a total of 827 patients (ranging between 15 to 78 years of age) with dense breasts who underwent CEM for the diagnostic workup of suspicious breast lesions.
The researchers found that CEM had pooled sensitivity and specificity rates of 95 percent and 81 percent, respectively, for diagnosing suspicious breast lesions. Enhanced lesions had an odds ratio (OR) value of 28.11 for relative malignancy, according to the study authors. They added that that the OR value of circumscribed breast lesions was 0.17 for relative malignancy.
Here one can see the use of surveillance contrast-enhanced mammography (CEM) for a woman with heterogeneously dense breast tissue and a past history of breast cancer and breast conserving surgery. A newly published meta-analysis revealed a 95 percent sensitivity for CEM in diagnosing suspicious lesions in women with dense breasts. (Images courtesy of Stephen Rose, M.D., and the Society of Breast Imaging.)
“These results suggested that CEM has a good diagnostic performance in dense breasts, especially in the case of non-negative examination results, which may be beneficial in reducing the number of unnecessary biopsies,” wrote Shu-ting Lin, who is affiliated with the Department of Radiology at the Second Affiliated Hospital of Fujian Medical University in Fujian, China, and colleagues.
The positive likelihood ratio (PLR) for CEM was 5.15, according to the study authors. Cautioning about the possibility of false positive results with CEM, the researchers suggested that increased iodine uptake for a widely variable number of precancerous and benign lesions such as fibroadenomas may have been contributing factors for the reported PLR. However, they also noted a negative likelihood ratio (NLR) of 0.06 with CEM.
“(This signals) that breast cancer can be excluded when the CEM indicates the presence of negative lesions,” maintained Lin and colleagues.
For two of the reviewed studies (including a total of 195 breast lesions) that evaluated lesion margins and internal enhancement, the study authors noted ORs relative to malignancy of .54 for homogenous enhancement, 1.69 for heterogeneous enhancement and .63 for rim enhancement. These factors had no statistical correlation with malignancy, according to the researchers.
In regard to study limitations, the authors acknowledged the heterogeneous nature of the cohorts from the reviewed studies. The researchers conceded the study’s focus on the workup of suspicious lesions as opposed to screening exams may limit broader extrapolation of the meta-analysis findings. The study authors also noted that assessment of lesion margins and enhancement findings was limited to a small number of the reviewed studies.
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