title: Diagnostic accuracy of contrast-enhanced spectral mammography in comparison to conventional full-field digital mammography in a population of women with dense breasts.
abstract: BACKGROUND
  Contrast-enhanced spectral mammography to compare clinical efficacy of contrast-enhanced spectral mammography (CESM) and conventional digital mammography (MMG) with histopathology as gold standard in dense breasts.
  
  
  METHODS
  A total of 143 breasts of 72 women who underwent CESM and MMG between 2011 and 2014 at Showa University Hospital were analyzed.
  
  
  RESULTS
  129 (90.2 %) of 143 breasts revealed dense breasts on MMG. 58 (40.6 %) of 143 breasts were diagnosed with breast cancer at histopathology. The remaining 85 breasts were diagnosed with benign findings after image assessments and/or core needle biopsy. CESM revealed 8 false-negative cases among 58 breast cancer cases (sensitivity 86.2 %) and 5 false-positive cases (specificity 94.1 %). Accuracy was 90.9 %. Conventional MMG was assessed true positive in 31 of 58 breast cancer cases (sensitivity 53.4 %) and false positive in 12 cases (specificity 85.9 %). Accuracy was 72.7 %. Sensitivity (p < 0.001), specificity (p = 0.016) and accuracy (p < 0.001) were significantly higher on CESM compared to MMG. MMG missed malignancy in 27 breasts. Of these, 25 were dense breasts. Of these 25, 20 (80.0 %) breasts were positive on CESM.
  
  
  CONCLUSIONS
  These findings suggest that CESM offers superior clinical performance compared to MMG. Use of CESM may decrease false negatives especially for women with dense breasts.
authors.affiliation: Department of Surgical Oncology, Showa University, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan. mikimori@med.showa-u.ac.jp.
authors.forename: Miki
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Surgical Oncology, Showa University, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan.
authors.forename: Sadako
authors.initials: S
authors.lastname: Akashi-Tanaka
authors.affiliation: Department of Surgical Oncology, Showa University, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Surgical Oncology, Showa University, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan.
authors.forename: Murasaki Ikeda
authors.initials: MI
authors.lastname: Daniels
authors.affiliation: Department of Surgical Oncology, Showa University, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Watanabe
authors.affiliation: Department of Radiology, Showa University, Tokyo, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Hirose
authors.affiliation: Department of Surgical Oncology, Showa University, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D062005:Biopsy, Large-Core Needle; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Asian women; Breast cancer; Contrast-enhanced spectral mammography; Dense breast