Contrast Mammogram versus Digital Mammogram for Evaluation of Multifocal and Multicentric Breast Cancer-A Prospective...

To assess the role of contrast enhanced mammography (CEM) as compared to conventional digital mammography (DM) in pre-operative evaluation for multifocal/multicentric breast carcinoma (BC). This prospective study was done on 35 females after obtaining approval from the institute ethics committee. DM and CEM were performed in standard craniocaudal (CC) and mediolateral oblique (MLO) positions and the findings were recorded as per the 5th edition of ACR-BIRADS lexicon. The findings included background parenchymal density and enhancement; presence of mass (size, shape, margin, density, enhancement features); presence of any satellite lesions or additional lesions on DM/CEM and its enhancement characteristics; any non-mass enhancement and associated findings. Sampling of the additional findings was done for equivocal radiology. The mean age was 45 years (26-76 years) and the mean size of index lesion was 3.44 cm (+ / - 1.25 cm) on DM. Presence of intraductal extension was seen in 5 patients (14.3%) on DM, whereas CEM could delineate it in 11 patients (31.4%). In addition, CEM showed better detection rate of multifocal disease (42.9% vs 65.7%), multicentric disease (17.1% vs 31.4%), and synchronous breast lesion (2.9% vs 5.7%). The accuracy and precision of tumour size measurement, multifocality and multicentricity were higher with CEM as compared to DM. Therefore, CEM may be a good alternative modality to assess the multifocality, multicentricity and disease extent in the preoperative setting and for those with limited access or contraindication to MRI.