Contrast-Enhanced Digital Mammography as Supplemental Exam

Contrast-enhanced digital mammography (CEDM) could be valuable as a supplemental imaging exam for women at increased risk for breast cancer who do not meet the criteria for MRI or for whom access to MRI is limited, according to a study published in the European Journal of Radiology.

Researchers from Memorial Sloan Kettering Cancer Center in New York, NY, undertook a pilot study to prospectively compare screening CEDM to breast MRI in women with an increased risk for breast cancer

A total of 318 women participated in the study; 307 were evaluable. All underwent CEDM within 30 days of a scheduled screening MRI; CEDM was interpreted blinded to MRI. The reference standard was defined as a combination of pathology and 2-year imaging follow-up.

The results revealed two invasive cancers and one ductal carcinoma in situ at the first round of screening: MRI detected all three cancers and CEDM detected the two invasive cancers. None of the three cancers was seen on the low energy mammograms, comparable to conventional mammography.

The researchers found five additional screen-detected cancers at 2-year imaging follow-up, but no palpable cancers. The positive predictive value 3 (PPV₃) for CEDM was 15% and 14% for MRI. The specificity of CEDM and MRI were 94.7% and 94.1% respectively.

The researchers concluded that CEDM could be valuable as a supplemental imaging exam for women at increased risk for breast cancer who do not meet the criteria for MRI or for whom access to MRI is limited. Further study is required, however.