Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis, synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast

Abstract

Objective: To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard. Methods: It was a prospective study, where consecutive females presenting to symptomatic breast clinic between April 2019 and June 2020 were evaluated with DBT. Females who were found to have heterogeneously dense (ACR type C) or extremely dense (ACR type D) breast composition detected on s2D MG were further evaluated with high-resolution breast ultrasound and thereafter with CEDM, but before the core biopsy or surgical excision, were included in the study. s2D MG was derived from post-processing reconstruction of DBT data set. Females with pregnancy, renal insufficiency or prior allergic reaction to iodinated contrast agent were excluded from the study. Image interpretation was done by two experienced breast radiologists and both were blinded to histological diagnosis. Results: This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24–72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, p < 0.0001), DBT alone (82.8%, p < 0.0001) and DBT + ultrasound (88.5%, p = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, p = 0.0002) and comparable to DBT alone (84.4%, p = 0.3586) and DBT + ultrasound (79.7%, p = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG. Conclusion: CEDM is an accurate diagnostic technique for cancer detection in dense breast. CEDM allowed a significantly higher number of breast cancer detection than the s2D MG, DBT alone and DBT supplemented with ultrasonography in females with dense breast. Advances in knowledge: CEDM is a promising novel technology with higher sensitivity and negative predictive value for breast cancer detection in females with dense breast in comparison to DBT alone or DBT supplemented with ultrasound.

Comparative Study of Digital Breast Tomosynthesis (DBT) with and without Ultrasound versus Breast Magnetic Resonance Imaging (MRI) in Detecting Breast Lesion

“…Our study showed that accuracy for DBT, DBT + USG and MRI were 79.1%, 83.3% and 79.1%, respectively. This was in accordance with a study done by Sudhir et al, whose study showed similar accuracy of 83.7% for DBT and 84.3% for DBT + USG; however, it was not statistically significant [ 24 ]. Saxena et al, on the other hand reported better accuracy for DBT and MRI, which were 90% and 98%, respectively [ 10 ].…”

“…NPV values in our study for all three modalities were less variable compared to other studies, which were 91.6%, 92.3% and 100% versus 81.7–100%, 86.3% and 89.5–100% for DBT, DBT + USG and MRI, respectively [ 8 , 10 , 24 ].…”

“…The PPV of all three modalities in our study were generally lower, which were 66.7% for DBT, 72.7% for DBT + USG and 64.3% for MRI, as compared to other literature review, i.e., 80.6–85.7% for DBT, 82.8% for DBT + USG and 71.1–96.6% for MRI [ 8 , 10 , 24 ]. This was likely due to the nature of lesion categorization in our study, i.e., BI-RADS 3 was categorized as malignant.…”

“…Systemic review of 2D mammography supplemented with screening USG showed improvement in median cancer detection rate of 4.2 (0.3–7.7) [ 16 ]. A study done by Sudhir et.al on contrast-enhanced digital mammography (CEDM) where they also included DBT and DBT + USG showed that there was a fair increased in sensitivity, which were 82.8% and 88.5% respectively [ 24 ]. Another study done by Dibble et al assessing supplementary USG to both digital mammography and DBT showed a slight increase in cancer detection rate; however, there was no significant difference [ 25 ].…”

Contrast-enhanced mammography for screening recalls: a problem-solving assessment tool ready for use?

“…The highest diagnostic performance is achieved when interpretation includes both low-energy and recombined images and jointly consider lesion morphologic characteristics and contrast enhancement [3]. Important is the high performance in women with dense breasts, and CEM was shown to have higher sensitivity and negative predictive value in females with dense breasts compared to DBT alone or DBT combined with ultrasound [4].…”