title: Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis--Comparison to contrast-enhanced breast MRI.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of contrast-enhanced digital mammography (CEDM) and contrast-enhanced tomosynthesis (CET) to dynamic contrast enhanced breast MRI (DCE-MRI) using a multireader-multicase study.
  
  
  METHODS
  Institutional review board approval and informed consents were obtained. Total 185 patients (mean age 51.3) with BI-RADS 4 or 5 lesions were evaluated before biopsy with mammography, tomosynthesis, CEDM, CET and DCE-MRI. Mediolateral-oblique and cranio-caudal views of the target breast CEDM and CET were acquired at 2 and 4 min after contrast agent injection. A mediolateral-oblique view of the non-target breast was taken at 6 min. Each lesion was scored with forced BI-RADS categories by three readers. Each reader interpreted lesions in the following order: mammography, tomosynthesis, CEDM, CET, and DCE-MRI during a single reading session.
  
  
  RESULTS
  Histology showed 81 cancers and 144 benign lesions in the study. Of the 81 malignant lesions, 44% (36/81) were invasive and 56% (45/81) were non-invasive. Areas under the ROC curve, averaged for the 3 readers, were as follows: 0.897 for DCE-MRI, 0.892 for CET, 0.878 for CEDM, 0.784 for tomosynthesis and 0.740 for mammography. Significant differences in AUC were found between the group of contrast enhanced modalities (CEDM, CET, DCE-MRI) and the unenhanced modalities (all p<0.05). No significant differences were found in AUC between DCE-MRI, CET and CEDM (all p>0.05).
  
  
  CONCLUSIONS
  CET and CEDM may be considered as an alternative modality to MRI for following up women with abnormal mammography. All three contrast modalities were superior in accuracy to conventional digital mammography with or without tomosynthesis.
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung 807, Taiwan, ROC.
authors.forename: Chen-Pin
authors.initials: CP
authors.lastname: Chou
authors.affiliation: Diversified Radiology of Colorado, Denver, CO, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Lewin
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Chiang
authors.affiliation: Department of Radiology, Golden Hospital, Pingtung, Taiwan, ROC.
authors.forename: Bao-Hui
authors.initials: BH
authors.lastname: Hung
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Tsung-Lung
authors.initials: TL
authors.lastname: Yang
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Jer-Shyung
authors.initials: JS
authors.lastname: Huang
authors.affiliation: National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Department of pathology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Jia-Bin
authors.initials: JB
authors.lastname: Liao
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Department of pathology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC. Electronic address: r2207759@ms19.hinet.net.
authors.forename: Huay-Ben
authors.initials: HB
authors.lastname: Pan
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Breast cancer; CEDM; CET; MRI; Screening mammogram; Tomosynthesis