Impact of contrast-enhanced mammography in surgical management of breast cancers for women with dense breasts: a dual-center, multi-disciplinary study in Asia

Abstract

Objective To evaluate the impact of pre-operative contrast-enhanced mammography (CEM) in breast cancer patients with dense breasts. Methods We conducted a retrospective review of 232 histologically proven breast cancers in 200 women (mean age: 53.4 years ± 10.2) who underwent pre-surgical CEM imaging across two Asian institutions (Singapore and Taiwan). Majority (95.5%) of patients had dense breast tissue (BI-RADS category C or D). Surgical decision was recorded in a simulated blinded multi-disciplinary team setting on two separate scenarios: (i) pre-CEM setting with standard imaging, and clinical and histopathological results; and (ii) post-CEM setting with new imaging and corresponding histological findings from CEM. Alterations in surgical plan (if any) because of CEM imaging were recorded. Predictors CEM of patients who benefitted from surgical plan alterations were evaluated using logistic regression. Results CEM resulted in altered surgical plans in 36 (18%) of 200 patients in this study. CEM discovered clinically significant larger tumor size or extent in 24 (12%) patients and additional tumors in 12 (6%) patients. CEM also detected additional benign/false-positive lesions in 13 (6.5%) of the 200 patients. Significant predictors of patients who benefitted from surgical alterations found on multivariate analysis were pre-CEM surgical decision for upfront breast conservation (OR, 7.7; 95% CI, 1.9-32.1; p = 0.005), architectural distortion on mammograms (OR, 7.6; 95% CI, 1.3–42.9; p = .022), and tumor size of ≥ 1.5 cm (OR, 1.5; 95% CI, 1.0-2.2; p = .034). Conclusion CEM is an effective imaging technique for pre-surgical planning for Asian breast cancer patients with dense breasts. Key Points • CEM significantly altered surgical plans in 18% (nearly 1 in 5) of this Asian study cohort with dense breasts. • Significant patient and imaging predictors for surgical plan alteration include (i) patients considered for upfront breast-conserving surgery; (ii) architectural distortion lesions; and (iii) tumor size of ≥ 1.5 cm. • Additional false-positive/benign lesions detected through CEM were uncommon, affecting only 6.5% of the study cohort.

Comparison of the effectiveness of contrast-enhanced mammography in detecting malignant lesions in patients with extremely dense breasts compared to the all-densities population

“…Such a discrepancy in the results may result primarily from the relatively small patient groups in the mentioned studies. Additionally, in studies on Asian populations, where extremely dense breasts are much more common than in Europe, CEM allowed a change in the extent of breast surgery in 18% of the examined patients with dense breasts by visualising new lesions or showing a more extensive infiltration of a neoplastic lesion [18,19]. Non-enhancing lesions on recombinant images are considered potentially benign.…”

Imaging the dense breast

“…The true positive rate was superior for CEM (72.0% vs. 42.5%), although the breakdown by density categories was not provided. A study assessing CEM for preoperative staging based in Singapore and Taiwan, where 95.5% of participants had dense breasts, found CEM changed surgical plans in 18% of patients 70 . For the 48% of cases where MRI was also performed, there was complete concordance for suspicious lesions detected by the two modalities.…”

Improving Women's Health in the 21st Century: Current Challenges, Medical Advancements and Future Prospects

“…Consequently, experts from the American College of Radiology recommend employing DBT as the optimal screening procedure for high-risk groups. The successful adoption and integration of this threedimensional imaging technique stand among many successes in combating the scourge of breast cancer among women; lending further motivation and hope towards swift recovery for affected individuals [40]. v) Cervical Cancer Screening Cervical cancer is a major health concern in many low-income nations, but it is one of the most preventable types of cancer.…”