Contrast-enhanced spectral mammography in recalls from the Dutch breast cancer screening program: validation of results in a large multireader, multicase study

Abstract

ObjectivesContrast-enhanced spectral mammography (CESM) is a promising problem-solving tool in women referred from a breast cancer screening program. We aimed to study the validity of preliminary results of CESM using a larger panel of radiologists with different levels of CESM experience.MethodsAll women referred from the Dutch breast cancer screening program were eligible for CESM. 199 consecutive cases were viewed by ten radiologists. Four had extensive CESM experience, three had no CESM experience but were experienced breast radiologists, and three were residents. All readers provided a BI-RADS score for the low-energy CESM images first, after which the score could be adjusted when viewing the entire CESM exam. BI-RADS 1-3 were considered benign and BI-RADS 4-5 malignant. With this cutoff, we calculated sensitivity, specificity and area under the ROC curve.ResultsCESM increased diagnostic accuracy in all readers. The performance for all readers using CESM was: sensitivity 96.9 % (+3.9 %), specificity 69.7 % (+33.8 %) and area under the ROC curve 0.833 (+0.188).ConclusionCESM is superior to conventional mammography, with excellent problem-solving capabilities in women referred from the breast cancer screening program. Previous results were confirmed even in a larger panel of readers with varying CESM experience.Key Points• CESM is consistently superior to conventional mammography • CESM increases diagnostic accuracy regardless of a reader’s experience • CESM is an excellent problem-solving tool in recalls from screening programs

Contrast‐enhanced spectral mammography: A potential exclusion diagnosis modality in dense breast patients

“…Using specific digital subtraction technique, CESM is able to erase the normal mammary gland and highlight the hypervascular lesions with better depiction of their frames and vasculatures. Preliminary studies have confirmed the superior sensitivity and specificity of CESM than conventional digital mammography . And several studies indicated the comparability of CESM to DCE‐MRI for breast cancer detection and diagnosis .…”

False-negative contrast-enhanced spectral mammography: use of more than one imaging modality and application of the triple test avoids misdiagnosis

“…In a multireader study of 199 women who underwent CESM during workup an abnormality detected on screening mammography, Lalji et al 5 noted an improvement in the diagnostic parameters of all 10 readers. Mean sensitivity increased from 93% to 96.9% and specificity from 35.9% to 69.7%.…”

Practical uses of contrast‐enhanced spectral mammography in daily work: A pictorial review

“…also highlighted the value of CESM as a problem‐solving tool following recall from a breast screening programme. This study found that CESM increased the diagnostic accuracy of readers regardless of level of expertise …”

“…They reported that CESM changed the diagnostic and treatment strategy in 21% of their patients . A study by Lalji et al . also highlighted the value of CESM as a problem‐solving tool following recall from a breast screening programme.…”

“…There are many indications for CESM, including the workup of inconclusive findings on mammography, assessment of breast symptoms, cancer staging and evaluation of response to neoadjuvant chemotherapy. Recent use as an alternative to MRI for high‐risk screening has also been reported …”