Over the course of a decade, contrast-enhanced mammography (CEM) offered robust sensitivity in breast cancer screening and ruling it out for women deemed to be at intermediate and high risk, according to new research.
For the retrospective study, recently published in the European Journal of Radiology, researchers reviewed screening CEM exams, conducted between 2012 and 2023, for 5,424 women (mean age of 54.8). The authors pointed out that 4,606 women (84.9 percent) had dense breasts and 1,134 women (20.9 percent) in the cohort had a family history of breast cancer.1
The study authors found that CEM provided an area under the curve (AUC) of 92.3 percent, a sensitivity rate of 95.9 percent and a negative predictive value (NPV) of 99.9 percent.1
“Considering breast cancer’s high morbidity and mortality, the trade-off of a higher detection rate against an increase in false positives and recall cases might be acceptable. Early detection and treatment can prevent advanced disease, increasing chances for successful treatment and cure. The potential prognostic benefit of employing CEM in screening programs warrants investigation through large-scale prospective studies,” wrote lead study author Vera Sorin, M.D., who is affiliated with the Department of Diagnostic Imaging at the Chaim Sheva Medical Center in Ramat Gan, Israel, and colleagues.
While the researchers noted a lowered specificity rate for CEM (81.8 percent) in contrast to what has been reported in the literature for full-field digital mammography (96.5 percent), they noted a 10 percent increase in specificity from initial CEM screening (79.2 percent) to a third screening round (89.2 percent).1,2
“This improvement over subsequent rounds may be attributed to the novelty of the modality and lack of previous similar studies for comparison during the first screening round, which could partly explain the initial low specificity and high overcall rates,” suggested Sorin and colleagues.
Three Key Takeaways
1. High sensitivity and NPV. CEM demonstrated robust sensitivity (95.9 percent) and a very high negative predictive value (99.9 percent) for breast cancer screening in intermediate- and high-risk women, making it a reliable screening method in these groups.
2. Effective for women with dense breasts. With a significant portion of the study population having dense breasts, CEM achieved a cancer detection rate (CDR) of 13.1 per 1,000 cases, which was higher than that reported for whole-breast ultrasound and 5.2 per 1,000 higher than low-energy mammography.
3. Increased detection rate over time: Specificity for CEM improved across screening rounds (from 79.2 percent to 89.2 percent), possibly due to increased familiarity with the modality and technique refinements, suggesting that CEM’s accuracy may improve with continued use in practice.
The researchers found that CEM had a cancer detection rate (CDR) of 13.1 per 1,000 cases. While this is lower than the reported CDR for supplemental breast magnetic resonance imaging (MRI), the study authors maintained that CEM’s CDR is higher than that of supplemental whole-breast ultrasound and provides a viable alternative to low-energy mammography views in high-risk populations (CDR of 7.9 per 1,000 exams).1,3,4
“In our study, CEM increased the incremental CDR by 5.2 per 1000 screenings compared to standard mammography in women with dense breasts or an elevated risk for breast cancer,” added Sorin and colleagues.
(Editor’s note: For related content, see “Is the Kaiser Score More Effective than BI-RADS for Assessing Contrast-Enhanced Mammography and MRI?.” “Could a Mammography Worklist in Order of Increasing Breast Density Bolster Interpretation and Efficiency?” and “Study: Contrast-Enhanced Mammography Offers Significantly Higher Sensitivity for Breast Cancer in Dense Breasts.”)
Beyond the inherent limitations of a single-center retrospective study, the authors noted a lack of information on high-risk lesions and incomplete information on patient risk factors. They also acknowledged a lack of separate positive predictive value (PPV) assessment for BI-RADS 4 and BI-RADS 5 cases, and no specificity assessment for low-energy mammography images.
References
1. Sorin V, Rahman N, Halabi N, Barash Y, Klang E, Sklair-Levy M. Evaluating ten years of breast cancer screening with contrast-enhanced mammography in women with intermediate-high risk. Eur J Radiol. 2024 Oct 28. doi: 10.1016/j.ejrad.2024.111807.
2. Skaane P, Hofvind S, Skjennald A. Randomized trial of screen-film versus full-field digital mammography with soft-copy reading in population-based screening program: follow-up ad final results of Oslo II study. Radiology. 2007;244(3):708-717.
3. Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI screening for women with extremely dense breast tissue. N Engl J Med. 2019;381(22):2091-2102.
4. Berg WA, Vourtsis A. Screening breast ultrasound using handheld or automated technique in women with dense breasts. J Breast Imag. 2019;1(4):283-296.
