Role of Dual Energy Contrast Enhanced Mammography in Characterization of Lesions in Edematous Breast

Abstract Background: Breast edema can be caused by benign or malignant diseases. Initial mammography and breast ultrasound examination are the routine investigative modalities. Some-times, mammography and ultrasonography can't characterize lesions especially in edematous breast. Contrast-enhanced digital mammography is a new breast imaging technique that can help in characterization of equivocal lesions. Aim of Study: The purpose of this study is to assess the role of dual energy contrast enhanced digital mammography in detection, evaluation and characterization of breast lesions in edematous breasts. Patients and Methods: This study was a cross sectional prospective study conducted at Ain-Shams University Hospitals at department of radiology and private radiology centers on 20 cases with breast oedema. No age predilection. Patients with previous surgery were included. Results: There were 12 patients (60%) with mass and 5 patients (25%) with history of previous surgery. Pathological lymph nodes were detected in 11 patients (55%), bilateral in one patient (9.1%), left sided in 5 patients (45.5%) and right sided in 5 patients (45.5%). As regard conventional mammog-raphy, 19 patients (95%) were positive for edema, while 11 patients (55%) were positive for a mass (irregular, central) and one patient (5%) was positive for calcifications. Regarding histopathology, there were 6 patients (30%) diagnosed with benign condition and 14 patients (70%) diagnosed with ma-lignant tumors. The 14 patients with malignant tumors, 92.9% out of them were true positive of contrast enhanced digital mammography and 7.1% were false negative. There were 6 patients histopathologically proved to be benign tumor and 83.3% out of them were true negative and 16.7% were false positive on contrast enhanced digital mammography. There was statistically significant agreement between histopathology and contrast enhanced digital mammography a yielded Kappa value of 0.762 and p-value <0.05. Conclusion: The addition of dual energy contrast enhanced digital mammography technique can significantly improve the detection of underlying breast lesions in edematous breasts.