title: Contrast-enhanced spectral mammography vs. mammography and MRI - clinical performance in a multi-reader evaluation.
abstract: OBJECTIVE
  To compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) to digital mammography (MG) and magnetic resonance imaging (MRI) in a prospective two-centre, multi-reader study.
  
  
  METHODS
  One hundred seventy-eight women (mean age 53 years) with invasive breast cancer and/or DCIS were included after ethics board approval. MG, CESM and CESM + MG were evaluated by three blinded radiologists based on amended ACR BI-RADS criteria. MRI was assessed by another group of three readers. Receiver-operating characteristic (ROC) curves were compared. Size measurements for the 70 lesions detected by all readers in each modality were correlated with pathology.
  
  
  RESULTS
  Reading results for 604 lesions were available (273 malignant, 4 high-risk, 327 benign). The area under the ROC curve was significantly larger for CESM alone (0.84) and CESM + MG (0.83) compared to MG (0.76) (largest advantage in dense breasts) while it was not significantly different from MRI (0.85). Pearson correlation coefficients for size comparison were 0.61 for MG, 0.69 for CESM, 0.70 for CESM + MG and 0.79 for MRI.
  
  
  CONCLUSIONS
  This study showed that CESM, alone and in combination with MG, is as accurate as MRI but is superior to MG for lesion detection. Patients with dense breasts benefitted most from CESM with the smallest additional dose compared to MG.
  
  
  CONCLUSIONS
  • CESM has comparable diagnostic performance (ROC-AUC) to MRI for breast cancer diagnostics. • CESM in combination with MG does not improve diagnostic performance. • CESM has lower sensitivity but higher specificity than MRI. • Sensitivity differences are more pronounced in dense and not significant in non-dense breasts. • CESM and MRI are significantly superior to MG, particularly in dense breasts.
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. eva.fallenberg@charite.de.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Fallenberg
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Florian F
authors.initials: FF
authors.lastname: Schmitzberger
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Heba
authors.initials: H
authors.lastname: Amer
authors.affiliation: Institut of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ingold-Heppner
authors.affiliation: Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Balleyguier
authors.affiliation: Department of Medical Imaging, St. Joseph-Stift Bremen, Bremen, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Diekmann
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Engelken
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Ritse M
authors.initials: RM
authors.lastname: Mann
authors.affiliation: Department of Radiology, Universitätsklinikum Jena, Jena, Germany.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Renz
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bick
authors.affiliation: Clinic of Radiology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.affiliation: Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Dromain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008327:Mammography / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Breast cancer; Breast neoplasms; Contrast media; Magnetic resonance imaging; Mammography