Short Article

Detecting Breast Cancer Using Contrast-Enhanced Mammography

A game changer in breast cancer screening and diagnosis

Contrast-enhanced mammography (CEM) is an increasingly powerful tool in the detection and diagnosis of breast cancer.1 Numerous studies have demonstrated CEM’s superior sensitivity and specificity over standard digital mammography in detecting and evaluating abnormal findings, particularly in women with dense breasts.1 When it comes to visualizing and evaluating breast lesions, in some studies CEM has also shown greater specificity than contrast-enhanced MRI (CEMRI). Notably, in one large, multi-center European study, CEM demonstrated a higher specificity in enhancing visualization of breast lesions with a positive predictive value of 97 percent vs. 85 percent for CEMRI, as well as slightly higher sensitivity in diagnosing breast lesions.2   

The role of CEM as an alternative to CEMRI for preoperative evaluation and guidance is growing, with published studies reporting the accuracy of CEM for detecting early stage and potentially invasive cancers as being similar to CEMRI.2,3 CEM has also shown fewer false positives than breast MRI, which can lead to overdiagnosis and overtreatment.1

CEM accurately detects breast lesions       

In CEM, an iodine-based contrast agent is administered intravenously prior to acquiring in a single compression of a standard digital mammogram, along with an additional image with a specific acquisition setting, thus enabling the delivery of a contrast-enhanced image. The aim is the visualization of the uptake of the iodine contrast agent within the breast, while cancelling the contrast between fatty and glandular tissues. This is key in terms of both detecting and evaluating breast lesions since it’s well established that breast cancer tumor growth stimulates the formation of new blood vessels, a process known as angiogenesis.4 CEM eliminates the visibility of the surrounding normal, or healthy, tissue via the subtraction of the mammographic images, thereby increasing the visibility of the lesions caused by angiogenesis.4  

Because angiogenesis is such an important prognostic indicator for breast carcinoma, the higher density of microvessels within the tumor can be an indicator of cancer.In one recent study designed to assess the accuracy of CEM in the detection of breast carcinoma, the results confirmed that malignant tumors show a higher number of blood and lymphatic vessels than benign lesions, and that CEM increased lesion visibility compared with conventional mammography.4   

CEM is a vital tool in breast cancer diagnosis

Numerous studies have shown the diagnostic accuracy of CEM in detecting abnormalities in dense breasts, visualizing angiogenesis in malignant lesions, and aiding in breast cancer diagnosis.4 To date, CEM has shown similar diagnostic accuracy compared with CEMRI, however, it’s less expensive, less time consuming, and provides easier interpretation of images than CEMRI.3 CEM’s is a valuable diagnostic tool in breast cancer will continue to play an increasingly pivotal role in the detection and diagnosis of malignant breast lesions.

 

References

  1. The Future of Contrast-Enhanced Mammography, American Journal of Radiology, February 2018. https://www.ajronline.org/doi/full/10.2214/AJR.17.18749 Accessed August 2, 2019.
  2. Comparison between Breast MRI and Contrast Enhanced Spectral Mammography, Med Sci Monit, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441288/pdf/medscimonit-21-1358.pdf Accessed August 25, 2019.
  3. Diagnostic Value of Contrast-Enhanced Digital Mammography versus Contrast-Enhanced Magnetic Resonance Imaging for the Preoperative Evaluation of Breast Cancer, J Breast Cancer, December, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310721/ Accessed August 25, 2019.
  4. Clinical Study of Contrast-Enhanced Digital Mammography and the Evaluation of Blood and Lymphatic Microvessel Density. Br J Radiol 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124926/pdf/bjr.20160232.pdf Accessed August 25, 2019.
  5. Evaluation of Tumor Angiogenesis of Breast Carcinoma Using Contrast-Enhanced Digital Mammography, AJR, November, 2006. https://www.ajronline.org/doi/full/10.2214/AJR.05.1944 Accessed August 25, 2019.