Role of Contrast Enhanced Mammography in Assessment of Suspicious Breast lesions

Abstract

Though widely established as the only screening imaging modality that can reduce breast cancer mortality, mammography has some limitations, such as lesions masked by normal fibroglandular tissue, lesions seen on only one view, and subtle architectural distortions. Partly because of these limitations, misses about 20% of invasive breast cancers.Also theaccuracy of mammography is limited in dense breasts where surrounding fibroglandular tissue decreases the conspicuity of lesions. Even when tumors are detected, the full extent of disease may not be clearly depicted. Studies compared sensitivity for contrast enhanced digital mammography with conventional mammography and results were 93% versus 78% for conventional mammography alone. Specificity was unchanged. Recent studiesdemonstrated that bilateral dual energy contrast enhanced mammography is easily accomplished and well tolerated. As opposed to the rapid washout seen with MR imaging, enhancement with dual energy contrast enhanced mammography remained present for at least 10 minutes after contrast agent infusion was complete. As such, the order in which the images were obtained did not appear to be critical. Dualenergy contrast enhanced mammography is comparable to MRI for the depiction of the index tumor in patients with known breast cancer, each has 96% sensitivity for detection of the lesions and this is significantly better than conventional digital mammography, which has only 81% sensitivity of lesions detection. This percentage is comparable to that reported in screening studies.