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Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme

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Abstract

Objectives

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.

Conclusion

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

Key Points

• 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.

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Acknowledgments

The scientific guarantor of this publication is Dr. M. Lobbes. The authors of this manuscript declare relationships with the following companies: M. Lobbes has received a speaking fee from GE Healthcare for two presentations on CESM. However, GE Healthcare did not provide any funding for this study. The authors had full control of data collection, data analysis and manuscript preparation at all times. The authors state that this work has not received any funding. One of the authors (P. Nelemans) has significant statistical expertise. Institutional review board approval was not required because in the Netherlands, research covered by the Medical Research Involving Human Subjects Act must be submitted to an accredited medical ethics committee for approval. Our medical ethics committee concluded that the research proposal of the current study does not, under Dutch law, require medical ethics approval because no extra burden is placed on research subjects. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    Marc B. I. Lobbes, Ulrich Lalji, Janneke Houwers, Estelle C. Nijssen & Joachim E. Wildberger

  2. Department of Epidemiology, Maastricht University, Maastricht, The Netherlands

    Patty J. Nelemans

  3. Department of Surgical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands

    Lori van Roozendaal, Marjolein L. Smidt & Esther Heuts

  4. GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands

    Marc B. I. Lobbes, Marjolein L. Smidt & Joachim E. Wildberger

Authors
  1. Marc B. I. Lobbes
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  2. Ulrich Lalji
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  3. Janneke Houwers
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  4. Estelle C. Nijssen
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  5. Patty J. Nelemans
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  6. Lori van Roozendaal
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  7. Marjolein L. Smidt
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  8. Esther Heuts
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  9. Joachim E. Wildberger
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Corresponding author

Correspondence to Marc B. I. Lobbes.

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Lobbes, M.B.I., Lalji, U., Houwers, J. et al. Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme. Eur Radiol 24, 1668–1676 (2014). https://doi.org/10.1007/s00330-014-3154-5

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  • DOI: https://doi.org/10.1007/s00330-014-3154-5

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