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Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?

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Abstract

The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) with mammography (MG) and combined CESM + MG in terms of detection and size estimation of histologically proven breast cancers in order to assess the potential to reduce radiation exposure. A total of 118 patients underwent MG and CESM and had final histological results. CESM was performed as a bilateral examination starting 2 min after injection of iodinated contrast medium. Three independent blinded radiologists read the CESM, MG, and CESM + MG images with an interval of at least 4 weeks to avoid case memorization. Sensitivity and size measurement correlation and differences were calculated, average glandular dose (AGD) levels were compared, and breast densities were reported. Fisher’s exact and Wilcoxon tests were performed. A total of 107 imaging pairs were available for analysis. Densities were ACR1: 2, ACR2: 45, ACR3: 42, and ACR4: 18. Mean AGD was 1.89 mGy for CESM alone, 1.78 mGy for MG, and 3.67 mGy for the combination. In very dense breasts, AGD of CESM was significantly lower than MG. Sensitivity across readers was 77.9 % for MG alone, 94.7 % for CESM, and 95 % for CESM + MG. Average tumor size measurement error compared to postsurgical pathology was −0.6 mm for MG, +0.6 mm for CESM, and +4.5 mm for CESM + MG (p < 0.001 for CESM + MG vs. both modalities). CESM alone has the same sensitivity and better size assessment as CESM + MG and was significantly better than MG with only 6.2 % increase in AGD. The combination of CESM + MG led to systematic size overestimation. When a CESM examination is planned, additional MG can be avoided, with the possibility of saving up to 61 % of radiation dose, especially in patients with dense breasts.

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Acknowledgments

We are grateful to Michaela Krohn, MD, Jasmin-Maya Singh, MD, Nikola Bangemann, MD, Angela Reles, MD, and Christiane Richter-Ehrenstein, MD, and for their contribution in the patient recruitment and inclusion. We are thankful to Prof. Marc Dewey for discussions about this paper and to Bettina Herwig for editorial support.

Conflict of interest

E.M.F. Financial activities related to the present article: GE Healthcare provided some funding to pay for the actual research per patient, but authors were completely in control of the patients and data. E.M.F. received payment for lecture or advisory board participation from GE, Bayer and Siemens and funding from Siemens, Bayer and GE. B.H. received payment for consultancy for Toshiba and is stock holder of all medical companies. F.D. received payment for lecture or advisory board participation from GE and Phillips and funding from GE, Bayer and Mevis. C.D. received funding from GE. U.B. received remuneration for License agreements and Royalties from Hologic and funding from Siemens, Hologic and Toshiba. D.M.R, A.U.N., K-J.W., B.I., and F.E. had no conflicts of interest.

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Authors and Affiliations

  1. Clinic of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Eva Maria Fallenberg, Diane M. Renz, Heba Amer & Bernd Hamm

  2. Department of Radiology, Institut Gustave Roussy, 39, Rue Camille Desmoullins, 94805, Villejuif Cedex, France

    Clarisse Dromain

  3. Department of Medical Imaging, St. Joseph-Stift Bremen, Schwachhauser Heerstraße 54, 28209, Bremen, Germany

    Felix Diekmann

  4. Institute of Pathology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Barbara Ingold-Heppner

  5. Interdisciplinary Breast Center, Department of Gynecology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Klaus J. Winzer

  6. Goodman Faculty of Life Sciences, Bar-Ilan University, Bldg 212, Room 210, 52900, Ramat Gan, Israel

    Avidan U. Neumann

  7. Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Ulrich Bick & Florian Engelken

  8. Clinic of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Germany

    Eva Maria Fallenberg

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  1. Eva Maria Fallenberg
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  2. Clarisse Dromain
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Correspondence to Eva Maria Fallenberg.

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Fallenberg, E.M., Dromain, C., Diekmann, F. et al. Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?. Breast Cancer Res Treat 146, 371–381 (2014). https://doi.org/10.1007/s10549-014-3023-6

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  • DOI: https://doi.org/10.1007/s10549-014-3023-6

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