Can contrast-enhanced mammography (CEM) have an impact for women recalled for suspicious findings on mammography exams?
For a new prospective study, recently published in the European Journal of Radiology, researchers examined the use of CEM in 198 women (with a total of 393 evaluated breasts) who were recalled after screening mammography exams. There were malignant findings in 73 of the 393 evaluated breasts and negative findings for 316 breasts at the original biopsy or follow-up exam, according to the study.1
The study authors found that CEM provided per-breast sensitivity of 96.1 percent, a 94.9 percent specificity, a 95.2 percent accuracy rate and an 82.2 percent positive predictive value (PPV).1
“ … Data from at least 3-year follow-up confirmed the high overall diagnostic performance of CEM in a cohort of women undergoing the assessment of suspicious findings from screening mammography,” wrote lead study author Sara Marziali, M.D., a radiology resident at the University of Milan in Milano, Italy, and colleagues.
The study authors emphasized the utility of CEM in ruling out malignancy and perhaps reducing unnecessary biopsies for women recalled for initially suspicious findings on mammograms.
“ ,,, The high negative predictive value (99 %) is one of the most important findings, playing in favor of CEM as a screening tool in women at higher-than-average risk,” noted Marziali and colleagues.
Three Key Takeaways
• High diagnostic performance in recalled patients. In women recalled after screening mammography, CEM demonstrated high per-breast sensitivity (96.1 percent), specificity (94.9 percent), and overall accuracy (95.2 percent), supporting its reliability as a problem-solving modality for suspicious screening findings.
• Strong ability to rule out malignancy. The very high negative predictive value (99 percent) suggests CEM may safely exclude cancer in many recalled cases with the potential to reduce unnecessary biopsies and additional diagnostic workup.
• Interval cancers remain uncommon but relevant. Although a small number of interval cancers were detected during follow-up, overall sensitivity remained comparable to prior meta-analyses, underscoring both the strength of CEM and the need for continued clinical vigilance and follow-up in recalled patients.
The researchers also noted detection of three interval cancers that included an incidental finding of a 5 mm contralateral invasive cancer for a woman who had a bilateral mastectomy. The other interval cancers were a 6 mm mucinous carcinoma and a ductal carcinoma in situ (DCIS) that were detected on the same side and sites of suspicious findings that triggered the initial recalls, according to the study authors.
“The three interval cancers observed during follow-up determined a global per-breast sensitivity of 96.1 %, a rate very close to the 95.1 % pooled sensitivity estimated in a meta-analysis for the combination of low-energy and recombined images,” pointed out Marziali and colleagues.1,2
(Editor’s note: For related content, see “Can Contrast-Enhanced Mammography Offer a Viable Option for Pre-Op Assessment of Pathologic Nipple Involvement?,” “Can Contrast-Enhanced Mammography be a Viable Screening Alternative to Breast MRI?” and “Contrast-Enhanced Mammography and High-Concentration ICM Dosing: What a New Study Reveals.”)
In regard to study limitations, the authors acknowledged that 5.1 percent of the original cohort was lost to follow-up and conceded a lack of assessment for molecular subtypes of breast cancer. Noting the high breast cancer incidence in a relatively small cohort of recalled patients, the researchers emphasized caution with extrapolation of the study findings to broader high-risk populations.
References
- Marziali S, Cozzi A, Magni V, et al. CEM in women prospectively assessed for screening recalls: pre-breast diagnostic performance with 3-year or longer follow-up. Eur J Radiol. 2026 Jan 1:195:112652. doi: 10.1016/j.ejrad.2025.112652. Online ahead of print.
- Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast cancer screening for women at higher-than-average risk: updated recommendations from the ACR. J Am Coll Radiol. 2023;20(9):902-914.
