Contrast-enhanced mammography may improve Breast cancer detection, suggests study

A new study published in the journal of Radiology showed that contrast-enhanced mammography (CEM) is superior to low-energy mammography in detecting breast cancer.

Similar to breast magnetic resonance imaging (MRI), contrast-enhanced mammography (CEM) is a new vascular-based breast imaging method that uses contrast medium to show neovascularity. A CEM study shows both anatomical and functional changes in the breast using iodinated contrast media. It consists of paired enhanced and unenhanced pictures for each of the four routine mammography views. CEM is a new technique that produces low-energy (LE) pictures that are visually comparable to recombined images that demonstrate lesion vascularity, like MRI, and full-field digital mammography (FFDM).

When used with FFDM but not with MRI, supplemental whole-breast US improves the detection rates of malignancy. Thus, to examine the effectiveness of CEM, LE images, and LE pictures enhanced with whole-breast US in breast cancer detection during screening, Joao Horvat and colleagues carried out this study.

Female volunteers scheduled for screening mammography and whole-breast US were recruited for this prospective trial between December 2014 and February 2019. Separate breast radiologists who were blind to the results of pictures from the other modality interpreted whole-breast US and CEM images (including LE and recombined images). Positive predictive value (PPV), negative predictive value, improper interpretation rate, and statistical variations in sensitivity and specificity were evaluated. At the lesion level, the biopsy referral rate and PPVs of conducted biopsies (PPV3) were computed.

Out of the 468 individuals (median age: 54 years [IQR: 48–59 years]; all female), 8 were diagnosed with 9 screen-detected cancers and 1 was seen at LE imaging with whole-breast US, 4 at LE imaging with whole-breast US, and 8 at CEM.

For LE pictures, the aberrant interpretation rate was 10.3%; for LE images with whole-breast US, it was 13.7%; and for CEM, it was 18.6%. For LE pictures, the biopsy referral rate was 15.0 out of 1000; for LE images with whole-breast US, it was 38.4 out of 1000; and for CEM, it was 42.7 out of 1000.

20 biopsies based on CEM, 7 biopsies based on LE pictures, and 18 biopsies based on LE images plus whole-breast US were suggested. Overall, when compared to LE pictures alone or LE images plus whole-breast US, CEM enhanced the identification of breast cancer.

Reference:

Horvat, J. V., Amir, T., Watt, G. P., Comstock, C. E., Nissan, N., Jochelson, M. S., & Sung, J. S. (2025). Comparison of Contrast-enhanced mammography and low-energy imaging with or without Supplemental whole-breast US in breast cancer detection. Radiology, 314(3), e242006. https://doi.org/10.1148/radiol.242006