Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting.
OBJECTIVE
To assess the diagnostic accuracy of contrast-enhanced spectral mammography (CESM), and gauge its "added value" in the symptomatic setting.


METHODS
A retrospective multi-reader review of 100 consecutive CESM examinations was performed. Anonymised low-energy (LE) images were reviewed and given a score for malignancy. At least 3 weeks later, the entire examination (LE and recombined images) was reviewed. Histopathology data were obtained for all cases. Differences in performance were assessed using receiver operator characteristic (ROC) analysis. Sensitivity, specificity, and lesion size (versus MRI or histopathology) differences were calculated.


RESULTS
Seventy-three percent of cases were malignant at final histology, 27% were benign following standard triple assessment. ROC analysis showed improved overall performance of CESM over LE alone, with area under the curve of 0.93 versus 0.83 (p<0.025). CESM showed increased sensitivity (95% versus 84%, p<0.025) and specificity (81% versus 63%, p<0.025) compared to LE alone, with all five readers showing improved accuracy. Tumour size estimation at CESM was significantly more accurate than LE alone, the latter tending to undersize lesions. In 75% of cases, CESM was deemed a useful or significant aid to diagnosis.


CONCLUSIONS
CESM provides immediately available, clinically useful information in the symptomatic clinic in patients with suspicious palpable abnormalities. Radiologist sensitivity, specificity, and size accuracy for breast cancer detection and staging are all improved using CESM as the primary mammographic investigation.
Nottingham Breast Institute, Nottingham University Hospitals, Nottingham, NG5 1PB, UK. Electronic address: sarah.tennant@nuh.nhs.uk.
S L
SL
Tennant
Nottingham Breast Institute, Nottingham University Hospitals, Nottingham, NG5 1PB, UK.
J J
JJ
James
Nottingham Breast Institute, Nottingham University Hospitals, Nottingham, NG5 1PB, UK.
E J
EJ
Cornford
Applied Vision Research Centre, Loughborough University, Loughborough, LE11 3TU, UK.
Y
Y
Chen
Nottingham Breast Institute, Nottingham University Hospitals, Nottingham, NG5 1PB, UK.
H C
HC
Burrell
Nottingham Breast Institute, Nottingham University Hospitals, Nottingham, NG5 1PB, UK.
L J
LJ
Hamilton
Nottingham Breast Institute, Nottingham University Hospitals, Nottingham, NG5 1PB, UK.
C
C
Girio-Fragkoulakis
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media