Role of Contrast Enhanced Mammography In Evaluation of Dense Breast Malignancy

Abstract

“Breast cancer is one of the most common cancer typesDespite major advances in mammography, at least 10-20% of breast cancers can go undetected using screening mammography alone.” “The accuracy of mammography is especially limited in dense breasts where the surrounding fibroglandular tissue decreases the conspicuity of the lesions. Even when lesions are detected the full extent of the disease may not be clearly depicted.” “Ultrasound is a complementary technique for mammography especially for dense breasts, but ultrasound is operator dependant and a time consumingexaminaiton, where findings have to be characterized during the procedure with a limited possibility of an independent second opinion of the already captured images.” “Contrast-enhanced MRI considered as the most sensitive detectiontechnique of the breast cancer currently, though it has high false positive rate and still carries the burden of high cost and low availability.” “Various techniques are being developed to minimize the risk of overlooking lesions in women with dense breasts. CEDM is a new technique, currently under evaluation to determine the best indications for it and to assess its possible diagnostic benefits. CEDM has the advantage of being a fast imaging technique, which could be performed using the current mammographicdigital system with specific hardwareandsoftware adaptations and has the advantage of being reproducible without operator dependency.” “Between the two techniques of CEDM currently being investigated (the temporal subtraction technique and the dual-energy technique), the dual-energy technique offers the possibility of imaging both breasts in two views (CC and MLO) during a single injection of contrast, less sensitive to patient motion and better tolerated by the patient due to shorter examination and breast compression time.” “The present study demonstrates that there can be a diagnostic gain achieved by combining dual-energy CEDM with conventional mammography especially in women with dense breasts. Some tumours were only detected with the help of contrast mammography. We also noted that the improvement in the sensitivity of detection of lesions was particularly interesting in breasts with edematous changes where it’s very difficult to localize lesions even with the help of complementary ultrasound examination.” “As compared the diagnostic proceduresto the standard of care for (mammography accompanied by complementry ultrasound), CEDM has a better diagnostic accuracy due to improved sensitivity and due to the significant reduction in the number of false negatives compared to mammography alone. CEDM increased the accuracy of BI-RADS assessment in 72.7% of malignant cases in our study. We note that it’s still difficult to differentiate between benign and malignant tumours on basis of enhancement, as is usual in MRI, which may be improved in the future with the development of standardized diagnostic criteria and imaging protocols for CEDM.” “The presents essay hints that CEDM is similar to breast MRI, it could be of particular interest for the assessment of the local extent of the disease. Actually in our study, dual-energy CEDM detected multifocal breast cancers in all cases and allowed more accurate lesion size evaluation.” “In conclusion dual-energy CEDM hada potential to to improve staging, toincrease the cancer detection rate and to improve the biopsyselection for the patients. Moreover it can be used for better assessment of recurrent disease and for monitoring of the response to chemotherapy.”