The Diagnostic Performance of Contrast Enhanced Spectral Mammography in Detecting Occult Breast Lesions in Patients with Dense Breasts

Abstract Background: Contrast Enhanced Spectral Mammography (CESM) is an evolving imaging technique using contrast media to enhance the sensitivity for breast cancer detection and to extend the capability of mammography. Aim of Study: To evaluate the added benefit of Contrast Enhanced Mammography (CESM) in detecting occult breast lesions that escaped conventional Digital Mammography (DM). Patients and Methods: 68 female patients (121 breasts) with dense breasts were enrolled in this study. CESM was performed after conventional DM which was negative. CESM results were compared to sonography and histopathologic results. Diagnostic accuracy of CESM in differentiating malignant from benign lesions was determined. Results: By using CESM, 18 cancers were detected in 68 patients with negative conventional mammographic studies. CESM had sensitivity 88.9%, specificity was 100%, PPV was 100%, NPV was 60% while the overall diagnostic accuracy of CESM was 85.7% in cancer detection. Conclusion: CESM has the potential to increase breast cancer detection rate over conventional DM especially in women with dense breasts. CESM has high specificity and positive predictive value in identifying malignant breast lesions. CESM is a promising tool for screening women with dense breasts and high risk for breast cancer.