Contrast-enhanced spectral mammography as work-up tool in patients recalled from breast cancer screening has low risks and might hold clinical benefits

Houben, Ivo; Voorde, P. Van de; Jeukens, Cécile R. L. P. N.; Wildberger, Joachim E.; Kooreman, Loes; Smidt, Marjolein L.; Lobbes, Marc

doi:10.1016/j.ejrad.2017.07.004

Cited by 58 publications

(39 citation statements)

References 21 publications

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“…Regarding radiation dose, data were scarcer: even though 45/84 articles (54%) mentioned this aspect, 17/45 (31%) did it without exhibiting original information but reporting observations from previous studies, therefore restricting the number of studies with new data to 28/84 (33%). Of these 28 studies, 19 (68%) provided an average glandular dose (AGD), 3 (16%) of them calculating it per-patient and ranging 1.5–6.9 mGy [8, 9, 58], 5/19 (26%) calculating it per-breast ranging 2.19–7.15 mGy and the remaining 11 (58%) reporting a per-view AGD ranging from 0.43 [61] to 2.65 mGy [101]. A comparison with DM was mentioned in 17 studies: only 1 (6%) documented a dose reduction (− 2%) for CESM compared to DM [32], while other 16 (94%) reported an increase in AGD ranging between 6.2% [85] and 100% [77].…”

Section: Resultsmentioning

confidence: 99%

“…Of note, 14/84 studies (29%) reported 30 adverse reactions out of 14012 patients, of which 26/30 (87%) were mild reactions limited to pruritus, hives, “scratchy throat” or other minor skin flushing that resolved promptly even when antihistamines or corticosteroids were not administered. In 3/30 (10%) cases [54, 58, 87], side effects were of moderate importance with nausea and vomiting, widespread urticaria resolved only after antihistamines and corticosteroids per os, and dyspnea that equally responded to oral antihistamine administration. Only 1/30 (3%) severe adverse reaction, requiring “intensive care” but resolved after short time, occurred in 14012 patients (0.007%) [61].…”

Section: Resultsmentioning

confidence: 99%

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Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review

et al. 2019

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We reviewed technical parameters, acquisition protocols and adverse reactions (ARs) for contrast-enhanced spectral mammography (CESM). A systematic search in databases, including MEDLINE/EMBASE, was performed to extract publication year, country of origin, study design; patients; mammography unit/vendor, radiation dose, low-/high-energy tube voltage; contrast molecule, concentration and dose; injection modality, ARs and acquisition delay; order of views; examination time. Of 120 retrieved articles, 84 were included from 22 countries (September 2003–January 2019), totalling 14012 patients. Design was prospective in 44/84 studies (52%); in 70/84 articles (83%), a General Electric unit with factory-set kVp was used. Per-view average glandular dose, reported in 12/84 studies (14%), ranged 0.43–2.65 mGy. Contrast type/concentration was reported in 79/84 studies (94%), with Iohexol 350 mgI/mL mostly used (25/79, 32%), dose and flow rate in 72/84 (86%), with 1.5 mL/kg dose at 3 mL/s in 62/72 studies (86%). Injection was described in 69/84 articles (82%), automated in 59/69 (85%), manual in 10/69 (15%) and flush in 35/84 (42%), with 10–30 mL dose in 19/35 (54%). An examination time < 10 min was reported in 65/84 studies (77%), 120 s acquisition delay in 65/84 (77%) and order of views in 42/84 (50%) studies, beginning with the craniocaudal view of the non-suspected breast in 7/42 (17%). Thirty ARs were reported by 14/84 (17%) studies (26 mild, 3 moderate, 1 severe non-fatal) with a pooled rate of 0.82% (fixed-effect model). Only half of CESM studies were prospective; factory-set kVp, contrast 1.5 mL/kg at 3 mL/s and 120 s acquisition delay were mostly used; only 1 severe AR was reported. CESM protocol standardisation is advisable.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review

et al. 2019

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“…CESM may decrease FNs especially for women with dense breasts [ 42 ]. Nevertheless, the administration of iodinated contrast agent is fundamental to the CESM and its routinely use as a screening procedure poses problems for allergic reaction and contrast-induced nephropathy, even if the risk of both these adverse reactions were demonstrated to be low [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis

Suter¹,

Pesapane

Agazzi

et al. 2020

The Breast

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Breast cancer diagnosis and staging is based on mammography, ultrasound, and magnetic resonance imaging (MRI). Contrast enhanced spectral mammography (CESM) has gained momentum as an innovative and clinically useful method for breast assessment. CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. We performed a systematic review of prospective trial to evaluate its diagnostic performance, following standard PRISMA-DTA. We used a bivariate random-effects regression approach to obtain summary estimates of both sensitivity and specificity of CESM. 8 studies published between 2003 and 2019 were included in the meta-analysis for a total of 945 lesions. The summary area under the curve obtained from all the study was 89% [95% CI 86%–91%], with a sensitivity of 85% [95% CI 73%–93%], and a specificity of 77% [95% CI 60%–88%]. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83% while a negative finding a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population, and at present time, it could be considered only as a possible alternative test for breast lesions assessment when mammography and ultrasound are not conclusive or MRI is contraindicated or not available.

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“…Nevertheless, both CESM and MRI present false positive cases, particularly in some fibroadenomas [10]. Moreover, the diagnosis by CESM can still be considered operator-dependent, also due to the current lack of objective measurement system of pathological enhancement (I/T curves, ROI) [10,52,53,60].…”

Section: Discussionmentioning

confidence: 99%

Fully Automated Support System for Diagnosis of Breast Cancer in Contrast-Enhanced Spectral Mammography Images

Fanizzi

Losurdo

Basile

et al. 2019

JCM

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Contrast-Enhanced Spectral Mammography (CESM) is a novelty instrumentation for diagnosing of breast cancer, but it can still be considered operator dependent. In this paper, we proposed a fully automatic system as a diagnostic support tool for the clinicians. For each Region Of Interest (ROI), a features set was extracted from low-energy and recombined images by using different techniques. A Random Forest classifier was trained on a selected subset of significant features by a sequential feature selection algorithm. The proposed Computer-Automated Diagnosis system is tested on 48 ROIs extracted from 53 patients referred to Istituto Tumori “Giovanni Paolo II” of Bari (Italy) from the breast cancer screening phase between March 2017 and June 2018. The present method resulted highly performing in the prediction of benign/malignant ROIs with median values of sensitivity and specificity of 87 . 5 % and 91 . 7 % , respectively. The performance was high compared to the state-of-the-art, even with a moderate/marked level of parenchymal background. Our classification model outperformed the human reader, by increasing the specificity over 8 % . Therefore, our system could represent a valid support tool for radiologists for interpreting CESM images, both reducing the false positive rate and limiting biopsies and surgeries.

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Contrast-enhanced spectral mammography as work-up tool in patients recalled from breast cancer screening has low risks and might hold clinical benefits

Cited by 58 publications

References 21 publications

Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review

Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review

Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis

Fully Automated Support System for Diagnosis of Breast Cancer in Contrast-Enhanced Spectral Mammography Images

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