Contrast-Enhanced Mammography Useful in Women with Breast Implants

Contrast-enhanced mammography (CEM) is an acceptable alternative to breast MRI for women who have breast implants, according to recently presented research.

CEM has already been shown to be an effective diagnostic or screening option for women with an increased breast cancer risk or who have dense breasts and cannot undergo breast MRI. In a poster presentation during the Society of Breast Imaging/American College of Radiology 2021 Annual Meeting, Molly P. Hogan, M.D., assistant attending provider in breast imaging service at Memorial Sloan Kettering Cancer Center, detailed the performance of CEM in women with breast implants.

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“It is feasible to utilize CEM in both a diagnostic and screening capacity in women with breast implants,” she said. “Women who are at increased risk of developing breast cancer or who require extent of disease evaluation, but are unable to undergo MRI evaluation, can consider CEM as a safe alternative.”

To evaluate efficacy, Hogan conducted a retrospective review of 104 women with breast implants who underwent 198 CEM exams (102 bilateral and 96 unilateral) between November 2014 and March 2020. She reviewed electronic medical records and imaging reports for exam indication, technique, and patient characteristics, such as breast density and implant type, and compared those outcomes to results from women without implants.

Of the women who had implants, 93 percent had dense breasts, and 32 had saline implants, 70 had silicone ones, and two women and one saline and one silicone. The vast majority of women (90 percent) had sub-pectoral implants with only 10 percent having retro-glandular implants. Most exams – 88 percent – were for screening due to increased risk, but 5 percent were for palpable abnormalities. The remaining scans were either to assess disease extent following neoadjuvant chemotherapy for a known malignancy or for a six-month follow-up.

According to her analysis, the accuracy of the 174 screening exams did not significantly differ from those conducted in the control group, and 99.5 percent of patients reported no complications.

Ultimately, she said, CEM can successfully be used clinically.

“Contrast enhanced digital mammography is a technically feasible and clinical useful exam in women with breast implants,” she concluded.