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Quantitative Breast Density in Contrast-Enhanced Mammography.

Gisella Gennaro1, Melissa L Hill2, Elisabetta Bezzon1

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|August 7, 2021
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Summary

Contrast-enhanced mammography (CEM) offers personalized screening for women with dense breasts. Volumetric breast density (VBD) measured using CEM is comparable to that from digital mammography (DM) or digital breast tomosynthesis (DBT).

Keywords:
breast densitycontrast-enhanced mammographymammographytomosynthesis

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Area of Science:

  • Radiology and Medical Imaging
  • Breast Imaging Technology
  • Oncology Screening

Background:

  • Contrast-enhanced mammography (CEM) shows promise for personalized breast cancer screening, especially for high-risk and dense-breasted women.
  • Accurate volumetric breast density (VBD) assessment is crucial for risk stratification and personalized screening strategies.
  • Comparing VBD measurements between CEM and conventional digital mammography (DM) or digital breast tomosynthesis (DBT) is essential for clinical integration.

Purpose of the Study:

  • To compare volumetric breast density (VBD) measurements obtained from low-energy CEM images with those from standard DM/DBT images.
  • To evaluate the consistency of VBD measurements across different mammographic techniques.
  • To identify factors influencing VBD differences between CEM and DM/DBT.

Main Methods:

  • Retrospective analysis of 150 women who underwent CEM between March 2019 and December 2020, with prior or subsequent DM/DBT examinations.
  • Automatic software was used to calculate VBD from low-energy CEM (LE-CEM) and DM/DBT images.
  • Statistical comparison using Wilcoxon tests and multivariate regression analysis to assess VBD differences and influencing variables.

Main Results:

  • Median VBD was comparable between LE-CEM (12.73%) and DM/DBT (12.39%), with no statistically significant difference (p = 0.5855).
  • VBD differences were associated with variations in glandular volume, breast thickness, compression parameters, contact area, and nipple-to-posterior-edge distance.
  • These associated variables reflect differences in breast positioning during image acquisition.

Conclusions:

  • Volumetric breast density measurements from low-energy CEM are comparable to those from standard DM/DBT.
  • CEM provides a reliable VBD assessment, supporting its role in personalized screening for women with dense breasts.
  • Breast positioning significantly influences VBD measurements, highlighting the need for standardized acquisition protocols.