Emerging research demonstrates that contrast-enhanced mammography (CEM) and abbreviated breast magnetic resonance imaging (MRI) provide significantly higher overall detection rates for breast cancer in comparison to automated whole breast ultrasound (ABUS).
For the randomized controlled trial, recently published in the Lancet, researchers compared the use of abbreviated MRI in 2,130 women, ABUS in 2,141 women and CEM in 2,035 women. All women in the cohort had dense breasts and negative findings on mammography exams, according to the study.
The study authors found that contrast-enhanced mammography provided the highest overall breast cancer detection rate (CDR) at 19.2/1000 exams in comparison to 17.4/1000 for abbreviated MRI and 4.2/1000 for ABUS.
For invasive breast cancer, the researchers noted a 15.7/1000 CDR for CEM, a 15/1000 CDR for abbreviated MRI and a 4.2/1000 CDR for ABUS.
“This study shows that contrast-enhanced techniques such as abbreviated MRI and contrast-enhanced mammography have a superior performance compared with whole breast ultrasound,” wrote lead study author Fiona J. Gilbert, MBChB, FRCR, who is affiliated with the Department of Radiology with the School of Clinical Medicine at the University of Cambridge in Cambridge, England, and colleagues.
The researchers also pointed out that abbreviated MRI and CEM were more adept with recognition of smaller invasive cancer lesions. According to the study authors, the average detected invasive lesion size was 10 mm for abbreviated MRI, 11 mm for CEM and 22 mm for ABUS.
Three Key Takeaways
1. Higher detection rates with CEM and abbreviated MRI. Both contrast-enhanced mammography (CEM) and abbreviated MRI significantly outperformed automated whole breast ultrasound (ABUS) in detecting breast cancer, particularly in women with dense breast tissue. CEM had the highest overall cancer detection rate (19.2/1000), followed closely by abbreviated MRI (17.4/1000) with ABUS substantially lower at 4.2/1000.
2. Smaller tumors detected more effectively. Abbreviated MRI and CEM were more effective at identifying smaller invasive breast cancers, detecting average lesion sizes of 10 mm and 11 mm respectively compared to 22 mm with ABUS. This suggests a potential for earlier-stage detection with these contrast-enhanced modalities.
3. Better predictive value but higher recall rates. While CEM and abbreviated MRI had higher recall rates (9.7 percent) compared to ABUS (4 percent), they also demonstrated superior positive predictive values (PPV3): 43.8 percent for CEM and 35.2 percent for abbreviated MRI versus 28.1 percent for ABUS, indicating better diagnostic accuracy despite more frequent follow-ups.
“The invasive (tumor) size found by abbreviated MRI and contrast-enhanced mammography was half the size of those found with ABUS,” noted Gilbert and colleagues.
The study authors noted higher recall rates for CEM and abbreviated MRI (9.7 percent) in comparison to ABUS (4 percent). However, they also pointed out significantly higher PPV3 for CEM (43.8 percent) and abbreviated MRI (35.2 percent) in contrast to ABUS (28.1 percent).
(Editor’s note: For related content, see “Study: Abbreviated Breast MRI Offers Equivalent Accuracy to mpMRI for Women with Dense Breasts,” “ECR Mammography Study: Pre-Op CEM Detects 34 Percent More Multifocal Masses than Mammography” and “Emerging AI Mammography Model May Enhance Clarity for Initial BI-RADS 3 and BI-RADS 4 Classifications.”)
In regard to study limitations, the authors acknowledged a lack of modality assessment with respect to impact on breast cancer-specific mortality and over-diagnosis. They also conceded that cancer detection rate information for full-field digital mammography was only obtained from one of the participating facilities in the study.
