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Current use and future perspectives of contrast-enhanced mammography (CEM): a survey by the European Society of Breast Imaging (EUSOBI)

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Abstract

Objectives

To perform a survey among members of the European Society of Breast Imaging (EUSOBI) regarding the use of contrast-enhanced mammography (CEM).

Methods

A panel of nine board-certified radiologists developed a 29-item online questionnaire, distributed to all EUSOBI members (inside and outside Europe) from January 25 to March 10, 2023. CEM implementation, examination protocols, reporting strategies, and current and future CEM indications were investigated. Replies were exploratively analyzed with descriptive and non-parametric statistics.

Results

Among 434 respondents (74.9% from Europe), 50% (217/434) declared to use CEM, 155/217 (71.4%) seeing less than 200 CEMs per year. CEM use was associated with academic settings and high breast imaging workload (p < 0.001). The lack of CEM adoption was most commonly due to the perceived absence of a clinical need (65.0%) and the lack of resources to acquire CEM-capable systems (37.3%). CEM protocols varied widely, but most respondents (61.3%) had already adopted the 2022 ACR CEM BI-RADS® lexicon. CEM use in patients with contraindications to MRI was the most common current indication (80.6%), followed by preoperative staging (68.7%). Patients with MRI contraindications also represented the most commonly foreseen CEM indication (88.0%), followed by the work-up of inconclusive findings at non-contrast examinations (61.5%) and supplemental imaging in dense breasts (53.0%). Respondents declaring CEM use and higher CEM experience gave significantly more current (p = 0.004) and future indications (p < 0.001).

Conclusions

Despite a trend towards academic high-workload settings and its prevalent use in patients with MRI contraindications, CEM use and progressive experience were associated with increased confidence in the technique.

Clinical relevance statement

In this first survey on contrast-enhanced mammography (CEM) use and perspectives among the European Society of Breast Imaging (EUSOBI) members, the perceived absence of a clinical need chiefly drove the 50% CEM adoption rate. CEM adoption and progressive experience were associated with more extended current and future indications.

Key Points

• Among the 434 members of the European Society of Breast Imaging who completed this survey, 50% declared to use contrast-enhanced mammography in clinical practice.

• Due to the perceived absence of a clinical need, contrast-enhanced mammography (CEM) is still prevalently used as a replacement for MRI in patients with MRI contraindications.

• The number of current and future CEM indications marked by respondents was associated with their degree of CEM experience.

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Abbreviations

CEM:

Contrast-enhanced mammography

EUSOBI:

European Society of Breast Imaging

IQR:

Interquartile range

MRI:

Magnetic resonance imaging

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Simone Schiaffino, Andrea Cozzi, Paola Clauser, Elisabetta Giannotti, Maria Adele Marino, Thiemo J. A. van Nijnatten, Pascal A. T. Baltzer, Marc B. I. Lobbes, Ritse M. Mann, Katja Pinker, Michael H. Fuchsjäger and Ruud M. Pijnappel contributed equally to this work.

Authors and Affiliations

  1. Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland

    Simone Schiaffino & Andrea Cozzi

  2. Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria

    Paola Clauser & Pascal A. T. Baltzer

  3. Cambridge Breast Unit, Addenbrooke’s Cambridge University Hospital NHS Foundation Trust, Cambridge, UK

    Elisabetta Giannotti

  4. Department of Biomedical Sciences and Morphologic and Functional Imaging, Università degli Studi di Messina, Messina, Italy

    Maria Adele Marino

  5. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

    Thiemo J. A. van Nijnatten

  6. GROW School for Oncology and Reproduction, Maastricht, The Netherlands

    Thiemo J. A. van Nijnatten

  7. Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands

    Marc B. I. Lobbes

  8. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

    Ritse M. Mann

  9. Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Ritse M. Mann

  10. Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Katja Pinker

  11. Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria

    Michael H. Fuchsjäger

  12. Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands

    Ruud M. Pijnappel

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  1. Simone Schiaffino
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Consortia

on behalf of the European Society of Breast Imaging (EUSOBI)

Corresponding author

Correspondence to Simone Schiaffino.

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Guarantor

The scientific guarantor of this publication is Dr. Simone Schiaffino, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Simone Schiaffino declares to have received travel support from Bracco Imaging, to be a member of the speakers’ bureau for GE Healthcare, and to be a product advisor for Arterys Inc. Katja Pinker declares being part of speakers bureaus for the European Society of Breast Imaging (active), Bayer (active), Siemens Healthineers (ended), DKD 2019 (ended), and Olea Medical (ended); consulting for Genentech, Merantix Healthcare, and AURA Health Technologies. All remaining authors declare no competing interest.

Paola Clauser, Ritse M. Mann, and Katja Pinker are members of the European Radiology Editorial Board. They have not taken part in the review or selection process of this article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this survey.

Ethical approval

No Institutional Review Board approval was required for this survey.

Study subjects or cohorts overlap

None of the study subjects or cohorts have been previously reported.

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• prospective

• observational

• multicenter study

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Schiaffino, S., Cozzi, A., Clauser, P. et al. Current use and future perspectives of contrast-enhanced mammography (CEM): a survey by the European Society of Breast Imaging (EUSOBI). Eur Radiol (2024). https://doi.org/10.1007/s00330-023-10574-7

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