Breast Digital Tomosynthesis versus Contrast-Enhanced Mammography: Comparison of Diagnostic Application and Radiation Dose in a Screening Setting

Abstract

This study aims to evaluate the Average Glandular Dose (AGD) and diagnostic performance of CEM versus Digital Mammography (DM) as well as versus DM plus one-view Digital Breast Tomosynthesis (DBT), which were performed in the same patients at short intervals of time. A preventive screening examination in high-risk asymptomatic patients between 2020 and 2022 was performed with two-view Digital Mammography (DM) projections (Cranio Caudal and Medio Lateral) plus one Digital Breast Tomosynthesis (DBT) projection (mediolateral oblique, MLO) in a single session examination. For all patients in whom we found a suspicious lesion by using DM + DBT, we performed (within two weeks) a CEM examination. AGD and compression force were compared between the diagnostic methods. All lesions identified by DM + DBT were biopsied; then, we assessed whether lesions found by DBT were also highlighted by DM alone and/or by CEM. We enrolled 49 patients with 49 lesions in the study. The median AGD was lower for DM alone than for CEM (3.41 mGy vs. 4.24 mGy, p = 0.015). The AGD for CEM was significantly lower than for the DM plus one single projection DBT protocol (4.24 mGy vs. 5.55 mGy, p < 0.001). We did not find a statistically significant difference in the median compression force between the CEM and DM + DBT. DM + DBT allows the identification of one more invasive neoplasm one in situ lesion and two high-risk lesions, compared to DM alone. The CEM, compared to DM + DBT, failed to identify only one of the high-risk lesions. According to these results, CEM could be used in the screening of asymptomatic high-risk patients.

Phantom-based analysis of variations in automatic exposure control across three mammography systems: implications for radiation dose and image quality in mammography, DBT, and CEM

“…Given the considerable variability across systems and AEC modes, it is recommended to be cautious in generalizing conclusions about dose level for specific modalities or differences in dose between modalities, especially when based on results derived from a single piece of equipment. Finally, it is important to note that the mean MGD differences between modalities observed in this phantom-based study may not be directly related to clinical dose results [ 17 – 21 ]. In fact, the uniform distribution of phantoms across the entire thickness range (20–70 mm PMMA) contrasts with the specific distributions of breast thicknesses in clinical populations.…”

History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century

“…Excellent results have also been demonstrated in its use in evaluating suspicious findings encountered with organized mammography screening in Europe where CEM seems to reduce the number of recalls in screening for benign lesions [76]. Despite these crucial results, its role as a potential substitute for screening mammography in some patient populations (e.g., highrisk patients with dense breasts) is only just beginning [77]. CEM also seems helpful in neoadjuvant chemotherapy response monitoring [78].…”

The verification of the utility of a commercially available phantom combination for quality control in contrast-enhanced mammography

“…This is particularly true for women with extremely dense breasts [15,16]. Compared to the standard tomosynthesis protocol, the diagnostic performance is comparable but with reduced mean glandular dose [17]. A few studies have also con rmed equivalent or better diagnostic accuracy of CEM compared to contrast-enhanced MRI (CE-MRI) [14,15,[18][19][20].…”

“…CEM does have some disadvantages, which include (i) use of ionizing radiation when compared to ultrasound and MRI, or a higher radiation dose to the patient when compared to standard digital mammography [17], and (ii) possible adverse effects from the iodinated contrast agent. Recent surveys on the additional radiation dose burden of CEM compared to standard mammography indicate the magnitude of increase is a less than double (ranging from 20-80% increase) in mean glandular dose, and less than 50% increase in entrance skin dose compared to standard mammogram [21,27,28].…”