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Nori Cucchiari J, Giudice L, Incardona LA, Di Filippo G, Bicchierai G, Cossu E, Bellini C, Vanzi E, De Benedetto D, Di Naro F, Boeri C, Vidali S, Miele V. Contrast enhanced mammography (CEM) guided biopsy using a prone table: A retrospective analysis of the preliminary experience in a single CEM referral center. Eur J Radiol 2024; 181:111779. [PMID: 39388793 DOI: 10.1016/j.ejrad.2024.111779] [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: 06/14/2024] [Revised: 08/01/2024] [Accepted: 10/06/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND This study evaluates the procedural efficacy and patient experience of Contrast Enhanced Mammography (CEM)-guided biopsies performed in a prone position using the Giotto Class 30,000 system. The emphasis is on the procedural advantages and clinical outcomes for "enhancing-only lesions" (EOLs). METHODS A retrospective analysis of 524 CEM examinations conducted from December 2023 to June 2024 at a tertiary referral center was performed. Patients referred for pre-surgical staging or evaluation of inconclusive findings from conventional imaging were included. The study utilized dual-energy imaging and vacuum-assisted biopsy techniques, focusing on patients with at least one EOL identified in their initial CEM. Exclusions were based on the absence of a primary or follow-up CEM conducted at our facility Endpoints of this work included procedure efficiency which was evaluated in terms of technical success (biopsy completion with adequate sampling), dose distribution and timing and detection of additional lesions and patients' comfort evaluation, based on the rate of complications (hematomas) and procedure interruption due to patients' specific request or fainting events. RESULTS Among the evaluated cases, 37 EOLs were biopsied. The average procedure time was 15.8 min. Biopsies were successfully completed in 100% of cases. However, complications occurred in 27% of cases, primarily as hematomas and a significant histological finding rate of 97.3% was recorded. CONCLUSIONS The use of the Giotto Class 30,000 system for CEM-guided biopsies in a prone position demonstrated high procedural success and was well-tolerated by patients, highlighting its potential to enhance procedural comfort and efficiency. These preliminary results validate the innovative approach, though further studies are required to solidify these findings and explore long-term outcomes.
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Affiliation(s)
- Jacopo Nori Cucchiari
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy
| | - Lucia Giudice
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata" viale Oxford 81, 00133 Rome, Italy
| | - Ludovica Anna Incardona
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy.
| | - Giacomo Di Filippo
- UOC Endocrinochirurgia Azienda Ospedaliera Universitaria Integrata Verona, 37134 VR, Italy
| | - Giulia Bicchierai
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy
| | - Elsa Cossu
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata" viale Oxford 81, 00133 Rome, Italy
| | - Chiara Bellini
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy
| | - Ermanno Vanzi
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy
| | - Diego De Benedetto
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy
| | - Federica Di Naro
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy
| | - Cecilia Boeri
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy
| | - Sofia Vidali
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy.
| | - Vittorio Miele
- Breast Radiology Department, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence FI, Italy
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Lobbes MBI, Theunissen J, Valentijn-Morsing A, Vissers Y, Bouwman L. Contrast-Enhanced Stereotactic Biopsy (CESB): Patient selection and practical considerations. Eur J Radiol 2024; 181:111768. [PMID: 39366192 DOI: 10.1016/j.ejrad.2024.111768] [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: 08/26/2024] [Revised: 09/18/2024] [Accepted: 09/26/2024] [Indexed: 10/06/2024]
Abstract
Since its introduction in 2012, contrast-enhanced mammography (CEM) has shown increased clinical relevance as a diagnostic tool in breast imaging. Its diagnostic accuracy is on par with breast MRI, rendering it a viable and potentially cost-effective alternative for breast MRI indications, especially in areas with lower accessibility to MRI. Like MRI, CEM occasionally shows 'CEM-only' lesions, i.e., areas of contrast enhancement without corresponding findings on low-energy images, ultrasound, or digital tomosynthesis. The current workaround usually consists of performing MRI-guided biopsy. However, contrast-enhanced stereotactic biopsy (CESB) offers a new alternative and has become commercially available since 2020. This narrative review will outline patient selection, the procedure, important considerations when performing CESB, and an overview of current literature.
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Affiliation(s)
- M B I Lobbes
- Zuyderland Medical Center, Department of Medical Imaging, Sittard-Geleen, the Netherlands.
| | - J Theunissen
- Zuyderland Medical Center, Department of Medical Imaging, Sittard-Geleen, the Netherlands
| | - A Valentijn-Morsing
- Zuyderland Medical Center, Department of Medical Imaging, Sittard-Geleen, the Netherlands
| | - Y Vissers
- Zuyderland Medical Center, Department of Surgery, Sittard-Geleen, the Netherlands
| | - L Bouwman
- Zuyderland Medical Center, Department of Surgery, Sittard-Geleen, the Netherlands; Maastricht University, Faculty of Scientific Engineering, Maastricht, the Netherlands
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Savaria D, Kaushik C. Brief communication: The current status of contrast-enhanced mammography in breast imaging. Clin Imaging 2024; 113:110213. [PMID: 38852214 DOI: 10.1016/j.clinimag.2024.110213] [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: 02/14/2023] [Revised: 04/23/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
Improvising and developing state of the art techniques for breast cancer detection have always been an area of great interest in the field of imaging. Adding intravenous contrast to any imaging study, is well-known to increase the sensitivity and specificity of detection of a pathological process, especially in the setting of neoplasia secondary to tumor neoangiogenesis. Contrast enhanced MRI is known to be highly sensitive breast cancer screening tool till date, however, has been limited by long scan times, claustrophobia experienced by some women and high false positive findings. Despite continued advances in digital mammography technique, significant limitations have always been experienced in detection of small cancers especially in the setting of dense breast parenchyma. Implementing dual energy subtraction technique to digital mammography, made contrast enhanced mammography a viable technique to improve cancer detection. We aim to discuss the status of contrast enhanced mammography in this brief communication, emphasizing technical background, image acquisition, clinical applications, and future directions.
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Affiliation(s)
- Daniel Savaria
- PGY-4, Department of Radiology, Thomas Jefferson University Hospital, United States of America
| | - Chhavi Kaushik
- Division of Breast Imaging, Department of Radiology, Thomas Jefferson University Hospital, United States of America.
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Alcantara R, Azcona J, Pitarch M, Arenas N, Castells X, Milioni P, Iotti V, Besutti G. Breast radiation dose with contrast-enhanced mammography-guided biopsy: a retrospective comparison with stereotactic and tomosynthesis guidance. Eur Radiol 2024:10.1007/s00330-024-10920-3. [PMID: 39143245 DOI: 10.1007/s00330-024-10920-3] [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: 02/18/2024] [Revised: 04/21/2024] [Accepted: 05/25/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVES This retrospective study aimed to compare the average glandular dose (AGD) per acquisition in breast biopsies guided by contrast-enhanced mammography (CEM), conventional stereotactic breast biopsy (SBB), and digital breast tomosynthesis (DBT). The study also investigated the influence of compressed breast thickness (CBT) and density on AGD. Furthermore, the study aimed to estimate the AGD per procedure for each guidance modality. METHODS The study included 163 female patients (mean age 57 ± 10 years) who underwent mammography-guided biopsies using SBB (9%), DBT (65%), or CEM (26%) guidance. AGD and CBT data were extracted from DICOM headers, and breast density was visually assessed. Statistical analyses included two-sample t-tests and descriptive statistics. RESULTS Mean AGD per acquisition varied slightly among CEM (1.48 ± 0.22 mGy), SBB (1.49 ± 0.40 mGy), and DBT (1.55 ± 0.47 mGy), with CEM presenting higher AGD at lower CBTs and less dose escalation at higher CBTs. For CBT > 55 mm, CEM showed reduced AGD compared to SBB and DBT (p < 0.001). Breast density had minimal impact on AGD, except for category A. The estimated AGD per procedure was approximately 11.84 mGy for CEM, 11.92 mGy for SBB, and 6.2 mGy for DBT. CONCLUSION The study found mean AGD per acquisition to be similar for CEM and SBB, with DBT slightly higher. CEM demonstrated higher AGD at lower CBT but lower AGD at higher CBT, indicating reduced dose escalation with increasing thickness. While breast density had minimal overall impact, variations were noted in category A. DBT was more dose-efficient per procedure due to fewer acquisitions required. CLINICAL RELEVANCE STATEMENT CEM guidance provides effective lesion visualization within safe radiation limits, improving the precision of percutaneous image-guided breast interventions and supporting its potential consideration in a wider range of breast diagnostic procedures. KEY POINTS Limited data exist on the AGD using CEM guidance for breast biopsies. CEM and SBB exhibit similar AGD per acquisition; DBT demonstrated the lowest AGD per procedure. Radiation from CEM guidance fits within safe limits for percutaneous image-guided breast interventions.
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Affiliation(s)
- Rodrigo Alcantara
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Radiology and Nuclear Medicine Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
| | - Javier Azcona
- Radiology and Nuclear Medicine Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Mireia Pitarch
- Radiology and Nuclear Medicine Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Natalia Arenas
- Radiology and Nuclear Medicine Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Xavier Castells
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | | | - Valentina Iotti
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Besutti
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Patel BK, Carnahan MB, Northfelt D, Anderson K, Mazza GL, Pizzitola VJ, Giurescu ME, Lorans R, Eversman WG, Sharpe RE, Harper LK, Apsey H, Cronin P, Kling J, Ernst B, Palmieri J, Fraker J, Mina L, Batalini F, Pockaj B. Prospective Study of Supplemental Screening With Contrast-Enhanced Mammography in Women With Elevated Risk of Breast Cancer: Results of the Prevalence Round. J Clin Oncol 2024:JCO2202819. [PMID: 39058970 DOI: 10.1200/jco.22.02819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/14/2024] [Accepted: 05/01/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE Contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) have shown similar diagnostic performance in detection of breast cancer. Limited CEM data are available for high-risk breast cancer screening. The purpose of the study was to prospectively investigate the efficacy of supplemental screening CEM in elevated risk patients. MATERIALS AND METHODS A prospective, single-institution, institutional review board-approved observational study was conducted in asymptomatic elevated risk women age 35 years or older who had a negative conventional two-dimensional digital breast tomosynthesis screening mammography (MG) and no additional supplemental screening within the prior 12 months. RESULTS Four hundred sixty women were enrolled from February 2019 to April 2021. The median age was 56.8 (range, 35.0-79.2) years; 408 of 460 (88.7%) were mammographically dense. Biopsy revealed benign changes in 22 women (22/37, 59%), high-risk lesions in four women (4/37, 11%), and breast cancer in 11 women (11/37, 30%). Fourteen cancers (10 invasive, tumor size range 4-15 mm, median 9 mm) were diagnosed in 11 women. The overall supplemental cancer detection rate was 23.9 per 1,000 patients, 95% CI (12.0 to 42.4). All cancers were grade 1 or 2, ER+ ERBB2-, and node negative. CEM imaging screening offered high specificity (0.875 [95% CI, 0.844 to 0.906]), high NPV (0.998 [95% CI, 0.993 to 1.000), moderate PPV1 (0.164 [95% CI, 0.076 to 0.253), moderate PPV3 (0.275 [95% CI, 0.137 to 0.413]), and high sensitivity (0.917 [95% CI, 0.760 to 1.000]). At least 1 year of imaging follow-up was available on all patients, and one interval cancer was detected on breast MRI 4 months after negative screening CEM. CONCLUSION A pilot trial demonstrates a supplemental cancer detection rate of 23.9 per 1,000 in women at an elevated risk for breast cancer. Larger, multi-institutional, multiyear CEM trials in patients at elevated risk are needed for validation.
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Affiliation(s)
- Bhavika K Patel
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Donald Northfelt
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Karen Anderson
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Gina L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic in Arizona, Phoenix, AZ
| | | | | | - Roxanne Lorans
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | | | - Laura K Harper
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Heidi Apsey
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Patricia Cronin
- Department of Surgical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Juliana Kling
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Brenda Ernst
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Jessica Fraker
- Department of Surgical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Lida Mina
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Felipe Batalini
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Barbara Pockaj
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
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Layden N, Sesnan G, Kessell M, Hardie M, Taylor D. Stereotactic biopsy with contrast-enhanced mammography: the initial Australian experience. J Med Imaging Radiat Oncol 2024; 68:393-400. [PMID: 38766916 DOI: 10.1111/1754-9485.13663] [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: 12/16/2023] [Accepted: 04/18/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Contrast-enhanced mammography (CEM) and MRI detect 'contrast-only' lesions (COLs) occult on standard breast imaging (ultrasound and conventional mammography). Until recently, MRI was the only reliable method of biopsy. This study presents the first Australian experience with CEM-guided biopsy (CEMBx) and the lessons learnt. METHODS A prospective audit of the first 15 consecutive patients who underwent CEMBx for COLs was performed. Indications for contrast imaging, patient and lesion characteristics, procedural details, radiation dose and pathology data were collected. RESULTS The 15 women were aged 37-81 years (mean 59 years). Indications for contrast imaging were problem solving (n = 3), moderate risk screening (n = 2), cancer staging (n = 9) and symptoms (n = 1). The COLs were non-mass (n = 14), mass (n = 1) and an enhancing asymmetry (n = 1). For one patient, two lesions were sampled during the same event. All lesions enhanced and were successfully sampled followed by marker clip insertion. Most biopsies (87.5%) were performed with the breast in cranio-caudal compression using a horizontal approach. Procedural duration ranged from 13 to 33 min (mean 22 min). Radiation dose was similar to standard stereotactic biopsy. Post-biopsy hematomas occurred in three patients, none required intervention. Clip displacement occurred in three cases. Core biopsy histopathology results were benign (n = 8), malignant (n = 7) and a borderline breast lesion (BBL) (n = 1). Patient satisfaction rates were high. Imaging follow-up is ongoing. CONCLUSIONS CEMBx is a quick, safe and reliable alternative to MRIBx to sample COLs.
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Affiliation(s)
- Natalie Layden
- Department of Medical Imaging, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Genevieve Sesnan
- Department of Medical Imaging, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Meredith Kessell
- Department of Medical Imaging, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Mireille Hardie
- Department of Anatomical Pathology, PathWest, Royal Perth Hospital, Perth, Western Australia, Australia
- University of Western Australia Medical School, Perth, Western Australia, Australia
| | - Donna Taylor
- Department of Medical Imaging, Royal Perth Hospital, Perth, Western Australia, Australia
- University of Western Australia Medical School, Perth, Western Australia, Australia
- Breast Screen Western Australia, 233 Adelaide Terrace, Perth, Western Australia, Australia
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Aribal E, Guldogan N, Seker ME, Yilmaz E, Turk EB. MRI only detected lesions: Can contrast enhanced mammography guided biopsy be an alternative method: Initial clinical findings. Eur J Radiol 2024; 173:111373. [PMID: 38364588 DOI: 10.1016/j.ejrad.2024.111373] [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: 10/28/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE This study aims to analyze our initial findings regarding CEM-guided stereotactic vacuum-assisted biopsy for MRI-only detected lesions and compare biopsy times by MRI-guided biopsy. MATERIALS AND METHODS In this retrospective analysis, CEM-guided biopsies of MRI-only detected breast lesions from December 2021 to June 2023were included. Patient demographics, breast density, lesion size, background parenchymal enhancement on CEM, lesion positioning, procedure duration, and number of scout views were documented. Initially, seven patients had CEM imaging before biopsy; for later cases, CEM scout views were used for simultaneous lesion depiction and targeting. RESULTS Two cases were excluded from the initial 28 patients with 29 lesions resulting in a total of 27 lesions in 26 women (mean age:44.96 years). Lesion sizes ranged from 4.5 to 41 mm, with two as masses and the remaining as non-mass enhancements. Histopathological results identified nine malignancies (33.3 %, 9/27), including invasive cancers (55.6 %, 5/9) and DCIS (44.4 %, 4/9). The biopsy PPV rate was 33.3 %. Benign lesions comprised 66.7 %, with 22.2 % high-risk lesions. The biopsy success rate was 93.1 % (27/29), and minor complications occurred in seven cases (25.9 %, 7/27), mainly small hematomas and one vasovagal reaction (3.7 %, 1/27). Median number of scout views required was 2, with no significant differences between cases with or without prior CEM (P = 0.8). Median duration time for biopsy was 14 min, significantly shorter than MRI-guided bx at the same institution (P < 0.001) by 24 min with predominantly upright positioning of the patient (88.9 %) and horizontal approach of the needle (92.6 %). CONCLUSION This study showed that CEM-guided biopsy is a feasible and safe alternative method and a faster solution for MRI-only detected enhancing lesions and can be accurately performed without the need for prior CEM imaging.
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Affiliation(s)
- Erkin Aribal
- Acibadem University, School of Medicine, Istanbul, Turkey; Acibadem Altunizade Hospital, Istanbul, Turkey.
| | | | | | - Ebru Yilmaz
- Acibadem Altunizade Hospital, Istanbul, Turkey.
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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] [Grants] [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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van Nijnatten TJA, Morscheid S, Baltzer PAT, Clauser P, Alcantara R, Kuhl CK, Wildberger JE. Contrast-enhanced breast imaging: Current status and future challenges. Eur J Radiol 2024; 171:111312. [PMID: 38237520 DOI: 10.1016/j.ejrad.2024.111312] [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: 12/21/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Contrast-enhanced breast MRI and recently also contrast-enhanced mammography (CEM) are available for breast imaging. The aim of the current overview is to explore existing evidence and ongoing challenges of contrast-enhanced breast imaging. METHODS This narrative provides an introduction to the contrast-enhanced breast imaging modalities breast MRI and CEM. Underlying principle, techniques and BI-RADS reporting of both techniques are described and compared, and the following indications and ongoing challenges are discussed: problem-solving, high-risk screening, supplemental screening in women with extremely dense breast tissue, breast implants, neoadjuvant systemic therapy (NST) response monitoring, MRI-guided and CEM- guided biopsy. RESULTS Technique and reporting for breast MRI are standardised, for the newer CEM standardisation is in progress. Similarly, compared to other modalities, breast MRI is well established as superior for problem-solving, screening women at high risk, screening women with extremely dense breast tissue or with implants; and for monitoring response to NST. Furthermore, MRI-guided biopsy is a reliable technique with low long-term false negative rates. For CEM, data is as yet either absent or limited, but existing results in these settings are promising. CONCLUSION Contrast-enhanced breast imaging achieves highest diagnostic performance and should be considered essential. Of the two contrast-enhanced modalities, evidence of breast MRI superiority is ample, and preliminary results on CEM are promising, yet CEM warrants further study.
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Affiliation(s)
- T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - S Morscheid
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - P A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - R Alcantara
- Radiology and Nuclear Medicine Department, Hospital del Mar, Barcelona, Spain
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - J E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
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Coffey K, Dixon LB, Sevilimedu V, Jochelson MS, Sung JS. Short-term follow-up of contrast-enhanced mammography lesions after negative breast MRI in women with elevated breast cancer risk. Eur J Radiol 2023; 168:111097. [PMID: 37738835 DOI: 10.1016/j.ejrad.2023.111097] [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: 04/25/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To determine the outcome of enhancing lesions detected on contrast-enhanced mammography (CEM) that had no correlate on magnetic resonance imaging (MRI) and underwent short-term follow-up CEM. METHODS In this retrospective single-center study, we identified patients with elevated breast cancer risk who had a CEM between 2014 and 2021 showing indeterminate enhancement on recombined images (BI-RADS 0, 3, 4) that had no correlate on subsequent MRI (performed within one month), and therefore underwent short-term follow-up CEM (performed within eight months). Medical records and imaging studies were reviewed to collect data on patient and lesion characteristics, and outcomes. Cancer incidence with 95% confidence interval (CI) was calculated. RESULTS This study included 71 women (median age 49 years) with 81 enhancing CEM lesions who underwent short-term follow-up CEM (median 6.2 months) after MRI reported no correlate. Of 81 lesions (median size = 0.7 cm), 73 (90%) were non-mass enhancement and 8 (10%) were enhancing masses. No sonographic correlate was identified for 75 lesions that had a same-day targeted ultrasound. Two cancers (2.5%, 95% CI 0.3-8.6) were diagnosed during the short-term follow-up period, one at 6-months (invasive ductal carcinoma) and one at 12-months (ductal carcinoma in situ). The remaining 79 lesions were benign at 6-month follow-up CEM and at one-year mammographic follow-up. CONCLUSIONS Follow-up CEM of MRI-occult lesions is prudent and may be reasonable to perform at one-year given the low incidence of cancer detected at six-months (one of 81) in our small study sample.
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Affiliation(s)
- Kristen Coffey
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
| | - Linden B Dixon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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