NEW research has shed light on the trade-offs of contrast-enhanced mammography (CEM) for imaging women with extremely dense breasts. Conducted by a team based at the Memorial Sloan Kettering Cancer Center, New York, USA, the study showed that while CEM offers high sensitivity, its specificity lags compared to standard mammography. However, the study suggests that the specificity of CEM with follow-up exams.
CEM has gained attention in recent years as a promising technique, especially for women with extremely dense breasts, a group for whom standard mammography struggles to detect cancers effectively. Dense breast tissue can obscure tumours on traditional mammograms, prompting researchers to explore alternative imaging modalities, such as CEM, which uses contrast enhancement to highlight suspicious areas more clearly.
This study evaluated data from 1,299 screening CEM exams performed on 609 women between 2012 and 2022. The average age of the participants was 50 years, and 16 cancers were detected, including two interval cancers. CEM found 11 of the 16 cancers, while standard mammography detected the remaining five.
The results revealed that CEM had a significantly higher sensitivity, at 88.9%, compared to 27.8% for standard mammography. However, the trade-off was a lower specificity, with CEM showing 88.9% specificity, versus 96.2% for standard mammograms. Despite this, the study showed that CEM’s specificity improved to 90.7% in follow-up exams, possibly due to radiologists being able to compare baseline and follow-up images for better accuracy.
The study authors concluded that CEM holds promise for addressing the challenges of breast cancer screening in women with dense breasts. They noted that the modality could be more cost-effective and widely available than MRI, though they acknowledged the need for future large-scale validation studies. “These large prospective trials will certainly help us identify who will benefit the most from screening CEM,” they commented.
Victoria Antoniou, EMJ
Reference
Nissan N et al. Diagnostic accuracy of screening contrast-enhanced mammography for women with extremely dense breasts at increased risk of breast cancer. Radiology. 2024;313(1):e232580.
