NEW research has demonstrated that combining contrast-enhanced mammography (CEM) and digital breast tomosynthesis (DBT) increases early breast cancer detection amongst females with a history of the disease. This is promising news for patients, study author Wendie Berg, University of Pittsburgh, Pennsylvania, USA, commented, as DBT alone has been shown to be insufficient for screening breast cancer.
Berg and colleagues analysed results from the Tomosynthesis or Contrast-Enhanced Mammography (TOCEM) trial, which investigates the use of three annual screenings with both DBT and CEM for females with breast cancer history. The team tracked the 3 years’ worth of results between October 2019‒December 2022. The data involved 1,273 females participating in the first year, 819 in the second, and 227 in the third year. Two radiologists interpreted both examinations. Berg’s group evaluated the effect of adding CEM to DBT on incremental cancer detection rate, cancer type and node status, and recall rate.
The researchers found that Year 1 cancer yield was 20 out of 1,273 (15.7 per 1,000 screenings) for DBT, and 29 out of 1,273 (22.8 per 1,000 screenings) for DBT plus CEM (P<0.001). Year 2 and 3 cancer yield was four out of 1,046 (3.8 per 1,000 screenings) for DBT, and eight out of 1,046 (7.6 per 1,000 screenings) for DBT plus CEM (P=0.001). Year 1 recall rate for observer 1 was 103 of 1,273 (8.1% incidence) for DBT alone, and 187 of 1,273 (14.7%) for DBT plus CEM (difference: 84 of 1,273; P<0.001). Year 2 and 3 recall rate was 40 of 1,046 (3.8%) for DBT, and 92 of 1,046 (8.8%) for DBT plus CEM (difference: 52 of 1,046; 5.0% [95% confidence interval: 3.7, 6.3]; P<0.001). In 18 breasts with cancer detected only at CEM after integration of both observers, 13 (72%) of cancers were invasive, and 88% with staging were N0.
The authors concluded that, although the combination of CEM and DBT increased the recall rate, this shows great promise for the detection of early cancer in females with a history of the disease. “Our interim results, while preliminary, support the use of CEM for annual supplemental screening in women with a personal history of breast cancer,” they added.
Reference
Berg WA et al. Addition of contrast-enhanced mammography to tomosynthesis for breast cancer detection in women with a personal history of breast cancer: prospective TOCEM trial interim analysis. Radiology. 2024;311(1):e231991.
