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  • Contrast-Enhanced Spectral Mammography More Effective than MRI in Newly Diagnosed Breast Cancer

    Radiology research explores potential of mammography technique. By Stephan Benzoker


    September 1, 2017

    Contrast-enhanced spectral mammography (CESM) outperformed MRI in evaluating the extent of breast cancer, with a significantly better positive predictive value (PPV) and fewer false positive findings, according to a recent Radiology study published ahead of print.

    CESM is quicker, less expensive and better tolerated by most patients, according to the study. If these findings are confirmed, more women would have a high quality diagnostic option in cases where MRI is not available or when contraindications for MRI exist.

    The retrospective study examined 52 women, average age of 50 years, who were recently diagnosed with unilateral breast cancer, to compare CESM and contrast-enhanced MRI in the detection of index and secondary cancers.

    CESM had a slightly lower sensitivity than MRI (94 percent vs. 99 percent), significantly higher PPV (93 percent vs. 60 percent), and significantly fewer false positive findings (five vs. 45), according to the study.

    “Contrast-enhanced spectral mammography detected similar rates of sites of cancer compared to MRI and demonstrated significantly fewer false positives than the MRI, meaning that CESM could potentially be even better than MRI,” said lead author Stephanie Lee-Felker, MD, assistant clinical professor in the Department of Radiology at UCLA Medical Center.

    Though MRI is the most sensitive modality, it possesses drawbacks, including a tendency to render false positives and present additional indeterminate imaging findings that doctors are obligated to biopsy or follow.

    “The reason we chose this specific population — patients who have a new cancer diagnosis undergoing imaging extent of evaluation to inform optimal treatment strategy — is that this is an area where breast MRI underperforms,” Dr. Lee-Felker said. “We wanted to investigate a modality that can potentially do better.”

    In the study, the 45 MRI false positives led to multiple additional core needle biopsies and nine surgical biopsies, which translated to months of treatment delays.

    “Ten women decided to get mastectomies after hearing that additional findings were detected on their MRI,” Dr. Lee-Felker said. “But in none of those cases was additional cancer actually found.”

    In terms of limitations, Dr. Lee-Felker stressed that the study was relatively small and that women with either obvious additional presumed disease or without additional suspicious lesions at MRI did not undergo CESM and were not included in this study.

    She cautioned that CESM may not be suitable for some women with impaired kidney function or who are allergic to the contrast agent. She also noted that CESM uses radiation, which MRI does not.

    “More research definitely needs to be done,” Dr. Lee-Felker said. “But if these women have the opportunity to have contrast-enhanced spectral mammography that basically provides the same or better information, they don’t have to feel like they are missing out on a very important test,” she noted.

    “Contrast-enhanced spectral mammography has a lot of potential as well as many applications that were not addressed in this study,” Dr. Lee-Felker said.




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    A 43-year-old woman who presented with spontaneous bloody left nipple discharge. Contrast-enhanced spectral mammographic image shows clumped NME in segmental distribution in upper outer quadrant of left breast (arrows). Ductal carcinoma in situ (DCIS) was diagnosed with MRI–guided core-needle biopsy.

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