Comparison of Contrast-enhanced Mammography with MRI Utilizing an Enriched Reader Study: A Breast Cancer Study...

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Limited research exists on contrast-enhanced mammography (CEM) as a breast cancer screening alternative to MRI.
• Growing interest in CEM necessitates further investigation into its efficacy compared to established MRI techniques.

Purpose of the Study:

• To evaluate if CEM is noninferior to breast MRI and abbreviated breast MRI (AB MRI).
• To determine if CEM is superior to 2D mammography for screening asymptomatic individuals.
• To assess CEM's performance in a population undergoing diagnostic work-up after screening.

Main Methods:

• Prospective collection of CEM and MRI data from asymptomatic individuals (December 2014 - March 2020).
• Enriched reader study with 12 radiologists interpreting anonymized and randomized CEM, AB MRI, and full MRI examinations.
• Receiver operating characteristic (ROC) analysis to compare diagnostic performance, focusing on CEM noninferiority to full MRI.

Main Results:

• CEM achieved a mean area under the ROC curve (AUC) of 0.91, comparable to full MRI (0.91) and AB MRI (0.89).
• CEM significantly outperformed 2D mammography (AUC 0.79; P < .001).
• No significant difference in AUC was found between CEM and either AB MRI or full MRI.

Conclusions:

• Contrast-enhanced mammography (CEM) is noninferior to both full breast MRI and abbreviated breast MRI (AB MRI) for breast cancer screening.
• CEM demonstrates superior diagnostic performance compared to 2D mammography.
• CEM presents a viable and effective alternative for breast cancer screening in asymptomatic populations.