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Schiaffino S, Cozzi A, Clauser P, Giannotti E, Marino MA, van Nijnatten TJA, Baltzer PAT, Lobbes MBI, Mann RM, Pinker K, Fuchsjäger MH, Pijnappel RM. Current use and future perspectives of contrast-enhanced mammography (CEM): a survey by the European Society of Breast Imaging (EUSOBI). Eur Radiol 2024; 34:5439-5450. [PMID: 38227202 DOI: 10.1007/s00330-023-10574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/08/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES To perform a survey among members of the European Society of Breast Imaging (EUSOBI) regarding the use of contrast-enhanced mammography (CEM). METHODS A panel of nine board-certified radiologists developed a 29-item online questionnaire, distributed to all EUSOBI members (inside and outside Europe) from January 25 to March 10, 2023. CEM implementation, examination protocols, reporting strategies, and current and future CEM indications were investigated. Replies were exploratively analyzed with descriptive and non-parametric statistics. RESULTS Among 434 respondents (74.9% from Europe), 50% (217/434) declared to use CEM, 155/217 (71.4%) seeing less than 200 CEMs per year. CEM use was associated with academic settings and high breast imaging workload (p < 0.001). The lack of CEM adoption was most commonly due to the perceived absence of a clinical need (65.0%) and the lack of resources to acquire CEM-capable systems (37.3%). CEM protocols varied widely, but most respondents (61.3%) had already adopted the 2022 ACR CEM BI-RADS® lexicon. CEM use in patients with contraindications to MRI was the most common current indication (80.6%), followed by preoperative staging (68.7%). Patients with MRI contraindications also represented the most commonly foreseen CEM indication (88.0%), followed by the work-up of inconclusive findings at non-contrast examinations (61.5%) and supplemental imaging in dense breasts (53.0%). Respondents declaring CEM use and higher CEM experience gave significantly more current (p = 0.004) and future indications (p < 0.001). CONCLUSIONS Despite a trend towards academic high-workload settings and its prevalent use in patients with MRI contraindications, CEM use and progressive experience were associated with increased confidence in the technique. CLINICAL RELEVANCE STATEMENT In this first survey on contrast-enhanced mammography (CEM) use and perspectives among the European Society of Breast Imaging (EUSOBI) members, the perceived absence of a clinical need chiefly drove the 50% CEM adoption rate. CEM adoption and progressive experience were associated with more extended current and future indications. KEY POINTS • Among the 434 members of the European Society of Breast Imaging who completed this survey, 50% declared to use contrast-enhanced mammography in clinical practice. • Due to the perceived absence of a clinical need, contrast-enhanced mammography (CEM) is still prevalently used as a replacement for MRI in patients with MRI contraindications. • The number of current and future CEM indications marked by respondents was associated with their degree of CEM experience.
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Affiliation(s)
- Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Elisabetta Giannotti
- Cambridge Breast Unit, Addenbrooke's Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Magni V, Cozzi A, Muscogiuri G, Benedek A, Rossini G, Fanizza M, Di Giulio G, Sardanelli F. Background parenchymal enhancement on contrast-enhanced mammography: associations with breast density and patient's characteristics. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01860-5. [PMID: 39060886 DOI: 10.1007/s11547-024-01860-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE To evaluate if background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM), graded according to the 2022 CEM-dedicated Breast Imaging Reporting and Data System (BI-RADS) lexicon, is associated with breast density, menopausal status, and age. METHODS This bicentric retrospective analysis included CEM examinations performed for the work-up of suspicious mammographic findings. Three readers independently and blindly evaluated BPE on recombined CEM images and breast density on low-energy CEM images. Inter-reader reliability was estimated using Fleiss κ. Multivariable binary logistic regression was performed, dichotomising breast density and BPE as low (a/b BI-RADS categories, minimal/mild BPE) and high (c/d BI-RADS categories, moderate/marked BPE). RESULTS A total of 200 women (median age 56.8 years, interquartile range 50.5-65.6, 140/200 in menopause) were included. Breast density was classified as a in 27/200 patients (13.5%), as b in 110/200 (55.0%), as c in 52/200 (26.0%), and as d in 11/200 (5.5%), with moderate inter-reader reliability (κ = 0.536; 95% confidence interval [CI] 0.482-0.590). BPE was minimal in 95/200 patients (47.5%), mild in 64/200 (32.0%), moderate in 25/200 (12.5%), marked in 16/200 (8.0%), with substantial inter-reader reliability (κ = 0.634; 95% CI 0.581-0.686). At multivariable logistic regression, premenopausal status and breast density were significant positive predictors of high BPE, with adjusted odds ratios of 6.120 (95% CI 1.847-20.281, p = 0.003) and 2.416 (95% CI 1.095-5.332, p = 0.029) respectively. CONCLUSION BPE on CEM is associated with well-established breast cancer risk factors, being higher in women with higher breast density and premenopausal status.
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Affiliation(s)
- Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Giulia Muscogiuri
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Adrienn Benedek
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Gabriele Rossini
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Marianna Fanizza
- Department of Breast Radiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giuseppe Di Giulio
- Department of Breast Radiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Lega Italiana per la Lotta contro i Tumori (LILT) Milano Monza Brianza, Piazzale Paolo Gorini 22, 20133, Milan, Italy
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Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97:695-704. [PMID: 38374651 PMCID: PMC11027262 DOI: 10.1093/bjr/tqae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, 84112, United States
| | - Samantha Salmon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
| | - Bradley D Weaver
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, 84112, United States
| | - Laurie L Fajardo
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
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Weaver OO, Kornecki A, Yang WT. Reply to: "Expanding Biopsy Options for Suspicious Breast Lesions: CT-Guided Biopsy Using a 3D-Printed Device". AJR Am J Roentgenol 2023; 221:402. [PMID: 37406201 DOI: 10.2214/ajr.23.29476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- Olena O Weaver
- The University of Texas MD Anderson Cancer Center, Houston, TX, , @OWeaverMD
| | - Anat Kornecki
- Western University, St. Joseph Health Care, London, ON, Canada
| | - Wei T Yang
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Lobbes MBI, Neeter LMFH, Raat F, Turk K, Wildberger JE, van Nijnatten TJA, Nelemans PJ. The performance of contrast-enhanced mammography and breast MRI in local preoperative staging of invasive lobular breast cancer. Eur J Radiol 2023; 164:110881. [PMID: 37201248 DOI: 10.1016/j.ejrad.2023.110881] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Breast MRI is considered the best modality for preoperative staging of invasive lobular carcinoma (ILC). However, contrast-enhanced mammography (CEM) shows comparable diagnostic performance to MRI, but evidence of CEM's accuracy in women diagnosed with ILC is scant. We aimed to retrospectively evaluate CEM and MRI accuracy in preoperative staging of ILC. METHODS ILC cases diagnosed between 2013 and 2021 were collected. For both modalities, tumour diameter was extracted from the reports. Bland-Altman plots were used to assess discrepancies between size measurements according to imaging and histopathological findings. CEM and MRI's ability to detect multifocal/contralateral cancer was expressed as sensitivity, specificity, and diagnostic odds ratios (DORs). Pairwise comparison of women undergoing both CEM and MRI was not performed. RESULTS 305 ILC-cases fulfilled preset inclusion criteria. Mean age was 63.7 years. Preoperative staging was performed using MRI or CEM in 266 (87.2%) and 77 (25.2%) cases, respectively. MRI and CEM overestimated tumour size by 1.5 and 2.1 mm, respectively. Sensitivity to detect multifocal disease was higher for MRI than for CEM (86% versus 78%), but specificity was lower for MRI (79% versus 92%). For detection of contralateral breast cancer, sensitivity for MRI was 96% versus 88% for CEM, and specificity was 92% and 99%, respectively. For both indications, DOR was higher for CEM, but differences were non-significant (p = 0.56 and p = 0.78). CONCLUSION CEM and MRI overestimate ILC size with comparable systematic and random errors. MRI's higher sensitivity for detection of multifocal/contralateral cancers is accompanied by lower specificity, but discriminative ability for both modalities was non-significant.
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Affiliation(s)
- Marc B I Lobbes
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Lidewij M F H Neeter
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Frank Raat
- Laurentius Hospital, Department of Radiology, P.O. Box 920, 6040AX Roermond, the Netherlands.
| | - Kim Turk
- Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands.
| | - Joachim E Wildberger
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Thiemo J A van Nijnatten
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Patricia J Nelemans
- Maastricht University, Department of Epidemiology, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
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Zhang M, Mesurolle B, Theriault M, Meterissian S, Morris EA. Imaging of breast cancer-beyond the basics. Curr Probl Cancer 2023:100967. [PMID: 37316336 DOI: 10.1016/j.currproblcancer.2023.100967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/12/2023] [Accepted: 05/20/2023] [Indexed: 06/16/2023]
Abstract
Imaging of breast cancer is the backbone of breast cancer screening, diagnosis, preoperative/treatment assessment and follow-up. The main modalities are mammography, ultrasound and magnetic resonance imaging, each with its own advantages and disadvantages. New emerging technologies have also enabled each modality to improve on their weaknesses. Imaging-guided biopsies have allowed for accurate diagnosis of breast cancer, with low complication rates. The purpose of this article is to review the common modalities for breast cancer imaging in current practice with emphasis on the strengths and potential weaknesses, discuss the selection of the best imaging modality for the specific clinical question or patient population, and explore new technologies / future directions of breast cancer imaging.
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Affiliation(s)
- Michelle Zhang
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada.
| | - Benoit Mesurolle
- Department of Radiology, Elsan, Pôle Santé République, Clermont-Ferrand, France
| | - Melanie Theriault
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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