Contrast Enhanced Mammography (CEM) Enhancing Asymmetry: Single-Center First Case Analysis

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• The latest Breast Imaging Reporting and Data System (BI-RADS) lexicon for contrast-enhanced mammography (CEM) includes enhancing asymmetries (EAs).
• Understanding the nature of lesions associated with EAs is critical for accurate interpretation in CEM.

Purpose of the Study:

• To investigate the correlation between enhancing asymmetries (EAs) and specific types of lesions detected via CEM.
• To determine the characteristics of EAs that are indicative of malignancy.

Main Methods:

• Retrospective analysis of 3359 CEM exams performed between 2019 and 2021.
• Detailed assessment of 64 identified EAs, including size, enhancing conspicuity, correlation with traditional imaging, biopsy results, and background parenchymal enhancement (BPE).

Main Results:

• Of 64 EAs, 29.69% were malignant (B5), 7.81% were indeterminate (B3), and 62.50% were benign or negative.
• EAs with higher enhancing conspicuity showed a significant correlation with a higher risk of B5 lesions (p=0.0071).
• Larger EAs were also significantly associated with an increased risk of malignancy (p=0.0274).

Conclusions:

• Enhancing asymmetries (EAs) in CEM can be associated with both benign and malignant lesions.
• EAs require thorough assessment, including review of low-energy images and consideration for second-look examinations, particularly for larger EAs with high enhancing conspicuity.