Can the combination of contrast-enhanced mammography (CEM) with high-concentration iodinated contrast medium (HCCM) have an impact for women with dense breasts and/or aggressive malignancies?
For a new retrospective study, recently published in Insights into Imaging, researchers assessed CEM and HCCM in 205 patients (mean age of 58), including 149 women with malignant lesions. The study authors noted that 43.4 percent of the cohort had BI-RADS C breast density and over 8 percent had BI-RADS D presentations. The breast cancer cases included 114 invasive cancers of no special type (NST), 21 cases of invasive lobular carcinoma (ILC), 13 cases of ductal carcinoma in situ (DCIS) and one case involving metastasis, according to the study.
The researchers found that CEM with HCCM (administered at 1.0 mL/kg body weight at an iodine delivery rate (IDR) of 1.2 gL/s) led to sensitivity between 96 to 97.3 percent sensitivity in comparison to 94.6 percent for ultrasound and 84.6 percent for mammography. Specificity for CEM and HCCM ranged between 83.9 to 87.5 percent versus 71.4 percent for ultrasound and 46.4 percent for mammography.
The study authors also noted an accuracy rate with CEM and HCCM ranging between 92.7 to 94.6 percent in contrast to 88.3 percent for ultrasound and 74.1 percent for mammography.
“Our study confirms that excellent diagnostic performance is achieved when performing CEM with an iodinated CM containing the highest concentration of iodine currently available (400 mgI/mL),” wrote lead study author Federica Pediconi, M.D., who is affiliated. With the Department of Radiological, Oncological and Pathological Sciences at the University of Rome in Italy, and colleagues.
In contrast to conventional mammography, the researchers also noted that the combination of CEM and HCCM facilitated higher sensitivity for invasive breast cancer of NST (94.7 to 96.5 percent vs. 85.1 percent) and ILC (100 percent vs. 90.5 percent).
Three Key Takeaways
1. Superior diagnostic performance. Contrast-enhanced mammography (CEM) with high-concentration iodinated contrast medium (HCCM, 400 mgI/mL) demonstrated significantly higher sensitivity (96–97.3 percent) and accuracy (92.7–94.6 percent) than both ultrasound and conventional mammography, particularly benefiting women with dense breasts or aggressive breast cancers.
2. Enhanced detection of aggressive cancers. CEM with HCCM achieved higher sensitivity for invasive cancers — especially invasive lobular carcinoma (100 percent) and invasive cancer of no special type (up to 96.5 percent) — compared to mammography, improving early detection of malignancies with high proliferative and metastatic potential.
3. Efficient contrast delivery. The combination of high iodine delivery rate (IDR) and reduced contrast volume allows shorter injection times and iodine savings while maintaining strong lesion enhancement, optimizing workflow and diagnostic clarity.
The study authors maintained that the combination of higher IDR and reduced ICM volume with CEM provides multiple benefits in the detection of invasive breast cancer.
“Clearly, this higher IDR will result in a greater enhancement in the vessels of interest, which is highly desirable for the improved early detection of malignant neoangiogenesis and the identification and diagnosis of fast-growing aggressive lesions with high proliferative and metastatic potential. Moreover, the lower volume administered while maintaining the same injection rate results in a shorter overall injection time and thus greater iodine saving,” posited Pediconi and colleagues.
(Editor’s note: For related content, see “Abbreviated MRI and Contrast-Enhanced Mammography Provide Fourfold Higher Cancer Detection than Breast Ultrasound,” “Contrast-Enhanced Mammography Study Reveals 24 Percent Lower Sensitivity with Moderate/Marked BPE” and “ECR Mammography Study: Pre-Op CEM Detects 34 Percent More Multifocal Masses than Mammography.”)
Beyond the inherent limitations of a retrospective study, the authors acknowledged that factors such as renal function and body mass index (BMI) were not assessed with respect to the impact upon CEM effectiveness. The researchers also conceded a lack of comparison of different ICM concentrations and injection protocols.
