Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting.

Area of Science:

• Radiology
• Medical Imaging
• Oncology

Background:

• Symptomatic breast abnormalities require accurate diagnostic tools.
• Traditional mammography has limitations in detecting and characterizing lesions.
• Contrast-enhanced spectral mammography (CESM) offers potential for improved diagnostic performance.

Purpose of the Study:

• To evaluate the diagnostic accuracy of CESM.
• To determine the added value of CESM in symptomatic patients.
• To compare CESM performance against low-energy (LE) mammography alone.

Main Methods:

• Retrospective review of 100 CESM examinations.
• Multi-reader assessment of anonymized low-energy (LE) images.
• Comparison of LE-only versus full CESM (LE and recombined images) reviews.
• Histopathology correlation for all cases.
• Receiver operator characteristic (ROC) analysis to compare performance.

Main Results:

• CESM demonstrated superior overall performance (AUC 0.93) compared to LE alone (AUC 0.83).
• CESM significantly increased sensitivity (95% vs. 84%) and specificity (81% vs. 63%).
• Tumor size estimation was more accurate with CESM, avoiding undersizing common with LE alone.
• CESM was considered a useful diagnostic aid in 75% of cases.

Conclusions:

• CESM provides immediate, clinically valuable information for symptomatic patients with suspicious findings.
• CESM enhances radiologist sensitivity, specificity, and size accuracy for breast cancer detection and staging.
• CESM is a valuable primary mammographic investigation in the symptomatic setting.