Diagnostic Value of Contrast-Enhanced Digital Mammography versus Contrast-Enhanced Magnetic Resonance Imaging for the Preoperative Evaluation of Breast Cancer

Abstract

Purpose: This study aimed to compare the diagnostic performance of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations, and to evaluate the effect of each modality on the surgical management of women with breast cancer.

Methods: This single-center, prospective study was approved by the Institutional Review Board, and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients who were diagnosed with invasive carcinoma (69/84) and ductal carcinoma in situ (15/84), and underwent both CEDM and CEMRI, were enrolled. Imaging findings and surgical management were correlated with pathological results and compared. The diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in the contralateral breast, was compared. The authors also evaluated whether CEDM or CEMRI resulted in changes in the surgical management of the affected breast due to imaging-detected findings.

Results: Eighty-four women were included in the analysis. Compared with CEMRI, CEDM demonstrated a similar sensitivity (92.9% [78/84] vs. 95.2% [80/84]) in detecting index cancer (p=0.563). For the detection of secondary cancers in the ipsilateral breast and occult cancer in the contralateral breast, no significant differences were found between CEDM and CEMRI (p=0.999 and p=0.999, respectively). Regarding changes in surgical management, CEDM resulted in similar changes compared with CEMRI (30.9% [26/84] vs. 29.7% [25/84], p=0.610). Regarding changes in surgical management due to false-positive findings, no significant differences were found between CEDM and CEMRI (34.6% [9/26] vs. 44.0% [11/25], p=0.782).

Conclusion: CEDM demonstrated a diagnostic performance comparable with CEMRI in depicting index cancers, secondary cancers, and occult cancer in the contralateral breast. CEDM demonstrated similar changes in surgical management compared with CEMRI.

Keywords: Breast neoplasms; Contrast media; Magnetic resonance imaging; Mammography.

Figure 1. Schematic figure of contrast-enhanced digital mammography, according to the time line; the image was provided courtesy of Hologic.

CC=craniocaudal; MLO=mediolateral oblique.

Figure 2. Correlation of the final assessment of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) with histopathologic results.

NOS=not otherwise specified; US=ultrasonography.

Figure 3. An asymptomatic 49-year-old woman confirmed with ductal carcinoma in situ (DCIS) on her left breast with previous history of breast-conserving surgery due to invasive ductal carcinoma on ipsilateral side of breast. (A) On contrast-enhanced magnetic resonance imaging (CEMRI), symmetric severe background parenchymal enhancement was noted. Axial maximal intensity projection image showed index cancer with regional non-mass enhancement (square) around previous operation site on her left breast and unexpected enhancing mass (arrow) in contralateral right breast. (B) On contrast-enhanced digital mammography, there was a regional non-mass enhancement correlated with index cancer (square) in left lower outer quadrant. And contralateral irregular enhancing mass (arrow) was also seen in right upper medial breast, identical to CEMRI. She underwent bilateral mastectomy, and the result was DCIS for left breast, and invasive tubular carcinoma for contralateral right breast (true positive).

Figure 4. A 38-year-old woman with proven invasive ductal carcinoma in her right breast. (A) She underwent contrast-enhanced magnetic resonance imaging, and axial maximal intensity projection image showed index cancer (arrows) with unexpected subareolar enhancing small mass (arrowheads) in right breast. (B) On contrast-enhanced digital mammography, the index cancer (arrow) was well visualized with another subareolar enhancing mass (arrowhead) in right breast. She underwent breast-conserving surgery for right breast, and the result was single invasive ductal carcinoma. A subareolar small enhancing mass was false positive lesion which confirmed as fibroadenomatoid lesion.

Figure 5. The effect of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) on the surgical management of breast cancer patients.