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7 Background: CESM is a new study using contrast and dual energy digital mammographic technology to detect contrast enhanced cancer that may be invisible on conventional mammogram. Limited studies have shown that adding CESM to diagnostic workup adjunct with mammogram and breast ultrasound does increase sensitivity for breast cancer detection. More studies are needed to compare the sensitivity of CESM to BMRI to further define the role of CESM in breast cancer diagnosis. Methods: This study involved 50 malignant breasts in 48 women retrospectively chosen from of 960 patients in our institution during the period of October 2012 to March 2014. Both CESM and BMRI were done for each patient within 30 days. The cancer diagnoses were confirmed by tissue diagnoses. The size of lesions was classified into three categories based on standard of breast cancer stages: 1 (0.2cm - < = 2 cm), 2 (2 cm < lesion < = 5 cm), 3 (> 5 cm). The enhancement intensity of both lesions and background has been quantified based on a scale of 0-3. Statistical significance was analyzed using T test for mean size of index cancer and mean score of enhancement intensity of background and lesions on CESM and BMRI. Sensitivity and positive predictive value (PPV) were calculated for both CESM and BMRI. Morphology consistence was calculated on both studies. Results: Both CESM and BMRI have sensitivity of 100% for breast cancer detection. CESM has a PPV of 98% versus 93% for BMRI. No statistical significance was identified on mean size of index cancer. The enhancement intensity of background and lesions is significantly higher on CESM than on BMRI (p < 0.01). The smallest cancer can be detected by both CESM and BMRI is less than 0.5 cm. Morphology consistence was 46/50 (92%). Conclusions: Our study indicates that CESM and BMRI have comparable high sensitivity on breast cancer detection. CESM has a higher PPV than BMRI that may indicate a better specificity (no significant difference due to the small sample size). Significantly less background enhancement intensity on CESM than on BMRI reflect an increased specificity. More studies need to be conducted for further evaluation.

Objective: Contrast enhanced spectral mammography (CESM) is a new study using contrast for early breast cancer detection. It utilizes dual energy digital mammographic technology to detect contrast enhanced cancer that may be invisible on conventional mammogram. Limited studies have shown that adding CESM to diagnostic workup adjunct with mammogram and breast ultrasound does increase sensitivity for breast cancer detection. More studies are needed to compare the sensitivity and positive predictive value (PPV) of CESM to BMRI to further define the role of CESM in breast cancer diagnosis. Methods: This study involved 50 malignant breasts in 48 women retrospectively chosen from of 960 patients in our institution during the period of October 2012 to March 2014. Both CESM and BMRI were done for each patient within 30 days. The cancer diagnoses were confirmed by tissue diagnoses. The number of malignant lesions was quantified in each breast. The size of lesions was classified into three categories based on standard of breast cancer stages: 1 (0.2cm -&lt;= 2cm), 2 (2cm&lt;lesion&lt;=5cm), 3(&gt;5cm). The enhancement intensity of both lesions and background has been quantified based on a scale of 0-3. Statistical significance was analyzed using T test for mean size of index cancer and mean score of enhancement intensity of background and lesions on CESM and BMRI. Sensitivity and PPV were calculated for both CESM and BMRI. Morphology consistence was calculated on both studies. Results: Both CESM and BMRI have sensitivity of 100% for breast cancer detection. CESM has a PPV of 98% versus 93% for BMRI. No statistical significance was identified on mean size of index cancer (3.7cm for CESM and 3.8cm for BMRI). The enhancement intensity of background and lesions is significantly higher on CESM than on BMRI (p&lt;0.01). The smallest cancer can be detected by both CESM and BMRI is less than 0.5 cm. Morphology consistence was 46/50 (92%). Of the 50 breasts, there was one false-positive finding at CESM mammography, and four false-positive findings at MR imaging. Conclusions: Our study indicates that CESM and BMRI have comparable high sensitivity on breast cancer detection. CESM has a higher PPV than BMRI that may indicate a better specificity (no significant difference due to the small sample size). Significantly less background enhancement intensity on CESM than on BMRI reflect an increased specificity. More studies need to be conducted for further evaluation. Citation Format: Luna Li, Lydia Liao, Pauline Germaine, Elizabeth Tinney, Kristin Brill, Karen Hendershott. Retrospective comparison of sensitivity and positive predictive value (PPV) of contrast enhanced spectral mammography (CESM) to contrast enhanced breast MRI (BMRI) in 50 malignant breasts [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-02-06.

Purpose: This presentation is to discuss the indications, protocol, interpretation and pitfalls of CESM using illustrations of breast malignant and benign cases performed in our institution, after a brief literature review. CESM characteristics for both benign and malignant lesions are defined after comparison to other imaging studies and correlation to final tissue diagnosis. Methods: 1000 CESM cases including 100 breast cancer and 200 benign lesions were retrospectively analyzed. These cases were performed in our institution from October 2012 to March 2014. GE Senographe Essential Full Field Digital System (SenoBright) was utilized for CESM studies. Both low and high energy images were obtained after intravenous 75-100cc Isovue 370 administration at flow rate of 1.5-2cc per second. Both low energy and subtracted images were reviewed on GE Centricity Imagecast on 5 megapigxel monitor. Abnormal CESM lesions underwent further evaluation and tissue sampling for a final diagnosis to determine the presence of breast cancer. Results: CESM is one of the contrast studies. It provides both morphologic and functional information of breast lesions. The sensitivity of CESM for cancer detection was 93-100% per patient in contrast to 95-100% of breast MRI. There are morphological and enhancement features for both malignant and benign lesions on CESM. CESM could pick up lesions when regular digital mammography and ultrasound are negative. CESM is a part of diagnostic study on selected patients. It has a short duration exam time and results are easily accessible. Some CESM artifacts are unique and commonly occurred. Conclusion: CESM is a new breast imaging contrast study. The sensitivity for breast cancer detection is comparable to breast MRI. With its easy accessibility and cost effectiveness, CESM may play an important role in breast cancer detection in conjunct with diagnostic mammography and breast ultrasound. Recognition of CESM artifacts helps to increase diagnostic accuracy. Citation Format: Lydia Liao, Luna Li, Pauline Germaine, Elizabeth Tinney, Kristin Brill, Karen Hendershott. Contrast enhanced spectral mammography (CESM) is a new breast imaging contrast study: A review of indications, protocol, interpretation and pitfalls [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-02-10.