Surveillance Contrast-Enhanced Mammography in Patients With Dense Breasts and a Personal History of Breast Cancer

To evaluate the diagnostic performance of contrast-enhanced mammography (CEM) for breast cancer surveillance in patients with dense breast tissue and a personal history of breast cancer.

In this single-center retrospective study, we reviewed consecutive CEM surveillance examinations performed between April 2022 and April 2025 in asymptomatic patients with a personal history of breast cancer and dense breasts. BI-RADS classifications, lesion characteristics, follow-up imaging, and histopathology were reviewed. Sensitivity, specificity, cancer detection rate (CDR), positive predictive values (PPV), and negative predictive values (NPV) were calculated using biopsy or at least 12 months imaging follow-up as reference standards.

A total of 176 patients underwent 376 CEM studies. Of the initial exams, 29.5% of patients (52 of 176) were classified as positive (BI-RADS 3 or 4; no BI-RADS 5 cases), with a CDR of 34 per 1000 exams. Sensitivity and specificity were 100% and 72.9%, respectively, with a PPV 1 of 11.5% and NPV of 100%. Over the study period, 39 biopsies yielded 8 malignancies in 7 patients, corresponding to a PPV3 of 20.5%. Three of the eight CEM-detected cancers (37.5%) were visible only on recombined images. Palpable axillary recurrences in two patients were outside the CEM field of view. One mild contrast reaction was recorded.

Although recall rates were higher than in prior studies, CEM demonstrated high sensitivity and NPV and substantial CDR; all of which were early-stage, node-negative cancers. These findings support broader consideration of CEM in intermediate- to high-risk surveillance settings, particularly where access to MRI is limited.