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. 2025 Feb:183:111883.
doi: 10.1016/j.ejrad.2024.111883. Epub 2024 Dec 7.

Non-enhancing asymmetries on screening contrast-enhanced mammography: Is further diagnostic workup required?

Noam Nissan  1 , Jeffrey S Reiner  1 , Victoria L Mango  1 , Hila Fruchtman-Brot  1 , Rosa Elena Ochoa Albiztegui  1 , Yuki Arita  1 , Jill Gluskin  1 , Tali Amir  1 , Kimberly Feigin  1 , Maxine S Jochelson  2 , Janice S Sung  1
Affiliations

Non-enhancing asymmetries on screening contrast-enhanced mammography: Is further diagnostic workup required?

Noam Nissan et al. Eur J Radiol. 2025 Feb.

Abstract

Objectives: Asymmetries on screening contrast-enhanced mammography (CEM) often lead to patient recall. However, in diagnostic settings, negative CEM has effectively classified these as normal or benign, questioning the need for further workup of non-enhancing asymmetries (NEAs).

Material and methods: A computational search of all screening CEM examinations performed between December-2012 and June-2021 was conducted to identify cases reporting NEAs. Their diagnostic workup was reviewed, and the positive predictive value for cancer was statistically compared to that of enhancing asymmetries on screening CEMs.

Results: During the study period, 97 cases of 106 NEAs were identified among 3,482 screening CEM exams (2.8 %). NEAs were classified as asymmetry (n = 83), focal asymmetry (n = 22), and global asymmetry (n = 1), with no cases of developing asymmetry. The mean size of NEAs was 1.0 ± 0.7 cm (range: 0.3-4.9 cm). Diagnostic workup for NEAs included additional mammographic views (AMV) (n = 63), AMV plus ultrasound (n = 30), AMV plus MRI (n = 1), and all three modalities (n = 3), leading to four biopsies. None of the NEAs were malignant on follow-up, as opposed to enhancing asymmetries (P < 0.05).

Conclusion: NEAs detected on CEM were relatively uncommon and were usually investigated with additional mammographic views and US, yielding no cancer. Ruling out malignancy based on lack of enhancement without further workup may reduce patient recall rates and improve CEMs specificity.

Keywords: Breast neoplasm; Cancer screening; Contrast-enhanced mammography; Mammography; Ultrasound.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Maxine Jochelson’s disclosure includes a previous paid lecture for GE, whose mammograms were utilized as part of the routine clinical work in our institute, regardless of this current study. The rest of the authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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