Feasibility of Contrast-Enhanced Spectral Mammography in Japan: A Pilot Study

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Contrast-enhanced spectral mammography (CESM) offers diagnostic capabilities similar to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).
• CESM is not widely used in Japan due to regulatory restrictions on iodinated contrast agents, limiting available evidence.
• There is a need to evaluate CESM's feasibility and effectiveness in the Japanese population.

Purpose of the Study:

• To assess the feasibility, diagnostic performance, and patient experience of CESM in Japanese women with breast cancer.
• To compare CESM with DCE-MRI and postoperative pathology for tumor detection and size measurement.
• To evaluate patient acceptance and preferences between CESM and DCE-MRI.

Main Methods:

• Nine patients with histologically confirmed breast cancer underwent both CESM and DCE-MRI prior to surgery.
• Radiologists independently assessed tumor size, BI-RADS category, and breast density, comparing findings with pathology.
• Patient-reported outcomes on examination comfort, duration, and modality preference were collected.

Main Results:

• CESM detected 90.9% of malignant lesions, while DCE-MRI detected 100%.
• Tumor size measurements from both CESM (r=0.95) and DCE-MRI (r=0.94) strongly correlated with pathology.
• No allergic reactions were reported, with an average glandular dose of 3.1 mGy for CESM. Patients favored CESM for its shorter duration.

Conclusions:

• CESM exhibits high diagnostic performance, comparable to DCE-MRI, especially in dense breasts.
• Its shorter examination time and positive patient feedback indicate CESM's potential as a valuable diagnostic option in Japan.
• Further clinical research is recommended to support the broader adoption of CESM in Japan.