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. 2024 Jul 21;14(14):1575.
doi: 10.3390/diagnostics14141575.

Validation of Contrast-Enhanced Mammography as Breast Imaging Modality Compared to Standard Mammography and Digital Breast Tomosynthesis

Nina Bartolović  1 , Ana Car Peterko  2 , Manuela Avirović  3   4 , Doris Šegota Ritoša  5 , Emina Grgurević Dujmić  6 , Petra Valković Zujić  1   7
Affiliations

Validation of Contrast-Enhanced Mammography as Breast Imaging Modality Compared to Standard Mammography and Digital Breast Tomosynthesis

Nina Bartolović et al. Diagnostics (Basel). .

Abstract

Contrast-enhanced mammography (CEM) is a relatively new imaging technique that allows morphologic, anatomic and functional imaging of the breast. The aim of our study was to validate contrast-enhanced mammography (CEM) compared to mammography (MMG) and digital breast tomosynthesis (DBT) in daily clinical practice. This retrospective study included 316 consecutive patients who underwent MMG, DBT and CEM at the Centre for Prevention and Diagnosis of Chronic Diseases of Primorsko-goranska County. Two breast radiologists independently analyzed the image data, without available anamnestic information and without the possibility of comparison with previous images, to determine the presence of suspicious lesions and their morphological features according to the established criteria of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The diagnostic value of MMG, DBT and CEM was assessed by ROC analysis. The interobserver agreement was excellent. CEM showed higher diagnostic accuracy in terms of sensitivity and specificity compared to MMG and DBT, the reporting time for CEM was significantly shorter, and CEM findings resulted in a significantly lower proportion of equivocal findings (BI-RADS 0), suggesting fewer additional procedures. In conclusion, CEM achieves high diagnostic accuracy while maintaining simplicity, reproducibility and applicability in complex clinical settings.

Keywords: breast cancer; contrast media; digital breast tomosynthesis; mammography.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Standards of Reporting of Diagnostic Accuracy (STARD 2015) flow chart of included patients with MMG, DBT and CEM. MMG, mammography; DBT, digital breast tomosynthesis; CEM, contrast-enhanced mammography.
Figure 2
Figure 2
MMG and DBT and CEM image data from our study. Standard MMG (A,B), and CEM (C,D) projections of the left breast of a 63-year-old female participant with breast cancer in UOQ. MMG, mammography; DBT, digital breast tomosynthesis; CEM, contrast-enhanced mammography; UOQ, upper outer quadrant.
Figure 3
Figure 3
Comparison of BI-RADS categories for MMG and DBT reports between two researchers. BI-RADS, Breast Imaging Reporting and Data System; MMG, mammography; DBT, digital breast tomosynthesis.
Figure 4
Figure 4
Comparison of BI-RADS categories for CEM reports between two researchers. BI-RADS, Breast Imaging Reporting and Data System; CEM, contrast-enhanced mammography.
Figure 5
Figure 5
Comparison of BI-RADS categories for MMG and DBT and CEM reports—researcher 1. BI-RADS, Breast Imaging Reporting and Data System; MMG, mammography; DBT, digital breast tomosynthesis; CEM, contrast-enhanced mammography.
Figure 6
Figure 6
Comparison of BI-RADS categories for MMG and DBT and CEM reports—researcher 2. BI-RADS, Breast Imaging Reporting and Data System; MMG, mammography; DBT, digital breast tomosynthesis; CEM, contrast-enhanced mammography.
Figure 7
Figure 7
Receiver operating characteristic curve analysis for MMG and DBT. MMG, mammography; DBT, digital breast tomosynthesis; CEM, contrast-enhanced mammography.
Figure 8
Figure 8
Receiver operating characteristic curve analysis for CEM. CEM, contrast-enhanced mammography.
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