Is Contrast-Enhanced Mammography a Viable Option for Diagnosing Invasive Lobular Carcinoma?

While magnetic resonance imaging (MRI) has been preferred over mammography for assessment of invasive lobular carcinoma (ILC) due to greater sensitivity, contrast-enhanced mammography (CEM) may be an emerging imaging alternative for this condition.

In a recent study, presented at the Radiological Society of North America (RSNA) conference, researchers assessed data from 94 patients who had preoperative CEM for different indications. Fifty-nine patients in the cohort also had preoperative MRI, according to the study.

The study authors found that CEM diagnosed 102 of 104 ILC lesions for a 98 percent sensitivity rate. The researchers also pointed out that 84 of the lesions (82 percent) demonstrated high conspicuity while 12 lesions (12 percent) had moderate conspicuity.

The use of contrast-enhanced mammography (CEM) helped reveal extensive invasive lobular carcinoma. Note the gross heterogeneous calcifications in the upper outer quadrant with some at the middle third level and other in the posterior third of the left breast on the low-energy images. Extensive non-mass enhancement of segmental distribution is evident in the recombined images. (Images courtesy of RSNA.)

“The results showed that CEM can be a useful alternative to MRI for the study of ILCs, providing a safe, immediately available, and rapid assessment of tumor extent,” wrote Rodrigo Alcantara, M.D., the section head of breast imaging in the Radiology Department at Hospital del Mar in Barcelona, Spain, and colleagues.

For CEM, the study authors noted that 50 percent of cases had minimal background parenchymal enhancement (BPE), followed by mild BPE (28 percent), moderate BPE (21 percent) and marked BPE (1 percent). For MRI, moderate BPE occurred in 41 percent of cases, followed by mild BPE (29 percent), minimal BPE (22 percent) and marked BPE (8 percent).

“In our internal clinical protocol, we recommend incorporating MRI into the preoperative assessment for patients with moderate or marked BPE on diagnostic CEM, particularly in cases of ILC or uncertain findings,” maintained Alcantara and colleagues.

(Editor’s note: For related content, see “Study: Contrast-Enhanced Mammography Changes Surgical Plan in 22.5 Percent of Breast Cancer Cases,” “Study Says Contrast-Enhanced Mammography Offers Comparable Breast Cancer Detection to MRI” and “Can DWI MRI Offer a Viable Non-Contrast Alternative for Breast Cancer Assessment?”)

In the low-energy (LE) CEM images, a mass was found in 31 percent of the cases. Other LE CEM findings included architectural distortion (27 percent), asymmetry (21 percent) and a mixed pattern of mass and calcification (10 percent). For the recombined (RC) CEM images, researchers detected a mass in 48 percent of cases and non-mass enhancement in 49 percent of cases. With preoperative MRI, the study authors noted mass detection in 60 percent of cases and non-mass enhancement in 37 percent of cases.

Reference

1. Alcantara R, Vila E, Rivera ENA, Diago MP, Saenz JA. Uncovering the unseen: the potential of CEM for invasive lobular carcinoma detection. Presented at the RSNA 2023 109th Scientific Assembly and Annual Meeting Nov. 26-30, 2023. Available at https://www.rsna.org/annual-meeting . Accessed December 15, 2023.