Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme.
OBJECTIVE
Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM.


METHODS
During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar's test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities.


RESULTS
Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0% (+3.1%), specificity to 87.7% (+45.7%), PPV to 76.2% (+36.5%) and NPV to 100.0% (+2.9%) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p < 0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p < 0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed.


CONCLUSIONS
CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening.


CONCLUSIONS
• CESM is feasible in the workflow of referrals from routine breast screening. • CESM is superior to mammography, even in low disease prevalence populations. • CESM has an extremely high negative predictive value for breast cancer. • CESM is comparable to MRI in assessment of breast cancer extent. • CESM is comparable to histopathology in assessment of breast cancer extent.
Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands, marc.lobbes@mumc.nl.
Marc B I
MB
Lobbes
Ulrich
U
Lalji
Janneke
J
Houwers
Estelle C
EC
Nijssen
Patty J
PJ
Nelemans
Lori
L
van Roozendaal
Marjolein L
ML
Smidt
Esther
E
Heuts
Joachim E
JE
Wildberger
D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D012017:Referral and Consultation; D012189:Retrospective Studies
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide