TREATMENT OF ADVERSE REACTIONS TO RADIOGRAPHIC CONTRAST MEDIA IN ADULTS

Diagnostic Performance of Contrast-enhanced Mammography: Comparison With MRI and Mammography

OBJECTIVE

To compare the diagnostic performance of contrast-enhanced mammography (CEM) with MRI and mammography (MG) based on histopathological results.

METHODS

In this IRB-approved study, written informed consent was obtained from all patients. Images from 40 patients (62 lesions) with suspicious findings on US between March 2018 and August 2018 were evaluated. Sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CEM, MRI, and MG were evaluated and compared within a 95% confidence interval. Maximum dimensions of lesions were measured and correlations of results were evaluated with Spearman's Rho test.

RESULTS

In the histopathological analysis, 66% (41/62) of lesions were malignant and 34% (21/62) of lesions were benign. Contrast-enhanced mammography, MRI, and MG had sensitivities of 100% (41/41), 100% (41/41), and 80% (33/41), respectively. The sensitivity of CEM and MRI was significantly better than that of MG (P = 0.03). The NPVs of CEM (100%, 7/7) and MRI (100%, 14/14) were statistically higher than the NPV of MG (60%, 12/20) (P = 0.03). The false-positive rates for CEM, MRI, and MG were 33% (7/21), 66% (14/21), and 42% (9/21), respectively. Contrast-enhanced mammography had a significantly lower false-positive rate than MRI (P < 0.001). Mammography had the highest false-negative rate, missing 19% (8/41) of malignant lesions.

CONCLUSION

Contrast-enhanced mammography has similar performance characteristics to MRI and improved performance characteristics relative to MG. In particular, CEM and MRI have similar sensitivity and NPVs and both are superior in each of these metrics to MG.

Safe and Appropriate Use of lodinated Radiographic Contrast Agents: Is There a Reason to Use High-Osmolality lodinated Contrast Agents?

The improved safety profile of low-osmolality compared with high-osmolality iodinated radiographic contrast agents supports the use of low-osmolality iodinated contrast agents in patients with a high risk for adverse reactions to contrast agents. Current pressures in the health care industry to minimize costs may warrant the continued use of high-osmolality agents in patients with relatively low risk for contrast reactions. Health-system management and pharmacists should continue to review the clinical and pharmacoeconomic issues surrounding the use of high-osmolality agents, because market factors have caused the prices of high-osmolality agents and second-generation low-osmolality agents to fluctuate. Moreover, the introduction of new agents will continue to change the risk—benefit–cost relationship.

Administration guidelines and appropriate patient monitoring are important, because both low-osmolality and high-osmolality agents carry the risk of adverse reactions. Pharmacologic pretreatment to alleviate adverse reactions to contrast agents when high-osmolality agents are used should be encouraged. Pharmacists—in cooperation with diagnostic imaging departments—should ensure that the use of iodinated radiographic contrast agents conforms to accepted guidelines.