CESM an effective breast cancer screening tool for at-risk patients
Researchers see value in using contrast-enhanced spectral mammography (CESM) to screen women at intermediate risk who have dense breast tissue, according to research published in the American Journal of Roentgenology.
“Several studies have shown that CESM has diagnostic accuracy superior to that of standard 2D digital mammography,” wrote author Vera Sorin, with Meirav Breast Center in Ramat Gan, Israel, and colleagues. “However, all of these studies were performed with small patient groups and with high prevalence of breast cancer (28–100 percent). There are limited data on the role of CESM as a screening examination.”
The authors studied data from 611 consecutively registered patients who underwent screening CESM between May 2012 and January 2017. Ninety-four percent of the group also underwent ultrasound as an adjunct to CESM. All women were asymptomatic and presented for routing screening mammography during the study period. Women younger than 40 years old were excluded from the study. More than 48 percent of the patients had a family history or personal history of breast cancer, and more than 93 percent had a breast density BI-RADS classification of 'C' or 'D.' The mean follow-up period was 20 months.
Overall, standard digital mammography had a sensitivity of 52.4 percent, specificity of 90.5 percent, positive predictive value (PPV) of 16.4 percent and negative predictive value (NPV) of 98.2 percent. CESM had a sensitivity of 90.5 percent, specificity of 76.1 percent, PPV of 11.9 percent and NPV of 99.6 percent. The adjunct ultrasound detected 73 additional suspicious findings, but they were all false-positive.
“CESM was significantly more sensitive than standard digital mammography for detection of breast cancer in the screening population of this study, composed of women with personal or family history of breast cancer and women with dense breasts,” the authors wrote. “No added benefit was found in the performance of ultrasound as an adjunct to negative CESM screens. Our findings suggest the potential of CESM as a supplemental screening imaging modality for women at intermediate breast cancer risk and women with dense breasts.”
Also, of the eight cancers seen only with CESM, seven were invasive.
“The advantage of the CESM technique is that it depicts microcalcifications on low-energy images in addition to nonmass enhancement on recombined images, allowing identification of DCIS even when microcalcifications are not seen,” the authors wrote.
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