Contrast-enhanced spectral mammography: what is the 'added value' in a symptomatic setting? Initial findings from a UK centre

Contrast-enhanced spectral mammography (CESM) is a new technology. Dual energy acquisitions during one exposure yield two sets of images: a low energy (LE) set, equivalent to standard full field digital mammography (FFDM); and a recombined set displaying contrast uptake. In our symptomatic breast service, specific patients, including those with a P4/5 clinical abnormality are offered CESM instead of FFDM. Despite encouraging data from Europe and the USA, there are, until now, no UK data to support its use in this setting

Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting

Aim. To assess the diagnostic accuracy of Contrast Enhanced Spectral Mammography (CESM), and gauge its “added value” in the symptomatic setting. Methods. At our institution, women aged 35-70 years with a suspicious or malignant clinical abnormality are offered CESM instead of standard Full-Field Digital Mammography (FFDM) as an initial imaging test. CESM is also offered to younger women whose ultrasound is suspicious, or who have biopsy-proven malignancy. It is occasionally used as an alternative to breast MRI following multi-disciplinary team discussion. We performed a retrospective multi-reader review of 100 consecutive CESM examinations. Anonymised Low Energy (LE) images were reviewed and given a score for malignancy. At least 3 weeks later, the entire examination (LE and recombined images) was reviewed. Pathology data was obtained for all cases. Differences in performance were assessed using receiver operative characteristic (ROC) analysis. Sensitivity, specificity and lesion size (vs MRI or histopathology) differences were calculated. Results. 73% cases were malignant at final histology, 27% were benign following standard triple assessment. ROC analysis showed improved overall performance of CESM over LE alone, with area under the curve of 93% vs 83% (p<0.025). CESM showed increased sensitivity (95% vs 84, p<0.025) and specificity (81% vs 63%, p<0.025) compared to LE alone, with all 5 readers showing improved accuracy. Tumour size estimation at CESM was significantly more accurate than LE alone, the latter tending to undersize lesions. In 75% of cases CESM was deemed a useful or significant aid to diagnosis. Conclusion. CESM provides immediately available, clinically useful information in the symptomatic clinic in patients with suspicious palpable abnormalities. Radiologist sensitivity, specificity and size accuracy for breast cancer detection and staging are all improved using CESM as the primary mammographic investigation

Accuracy of GE digital breast tomosynthesis vs supplementary mammographic views for diagnosis of screen-detected soft-tissue breast lesions

Objective: To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft-tissue mammographic abnormalities. Methods: Women recalled for further assessment of soft-tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two-view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymization of cases, there was also a retrospective multireader review. The readers first read bilateral standard two-view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five-point scale. The same readers then read bilateral standard two-view DM together with two-view DBT. Pathology data were obtained. Differences were assessed using receiver operating characteristic analysis. Results: The study population was 342 lesions in 322 patients. The final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two-view DM plus DBT was at least equivalent to the performance of two-view DM and standard mammographic supplementary views—the area under the curve (AUC) was 0.946 and 0.922, respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review—AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. Conclusion: The accuracy of GE DBT in the assessment of screen detected soft-tissue abnormalities is equivalent to the use of standard supplementary mammographic views. Advances in knowledge: The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft-tissue screen-detected abnormalities