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Diagnostic Performance of Contrast-enhanced Mammography: Comparison With MRI and Mammography
Sabahattin Yüzkan1, Duygu Cengiz1, İlhan Hekimsoy1
1Ege University School of Medicine, Department of Radiology, Izmir, Turkey.
Insights
Contrast-enhanced mammography (CEM) and MRI show superior diagnostic performance compared to standard mammography (MG) for suspicious lesions. CEM offers similar sensitivity and negative predictive values to MRI, with a lower false-positive rate than MRI.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Mammography (MG) is a standard screening tool for breast cancer.
- Magnetic resonance imaging (MRI) offers high sensitivity but is costly and has limitations.
- Contrast-enhanced mammography (CEM) combines mammography with contrast dye for improved visualization.
Purpose of the Study:
- To compare the diagnostic performance of CEM, MRI, and MG.
- To evaluate sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.
- To correlate imaging findings with histopathological results.
Main Methods:
- Retrospective analysis of 62 suspicious lesions in 40 patients.
- Evaluation of CEM, MRI, and MG performance metrics.
- Comparison of diagnostic accuracy using histopathological data.
Main Results:
- CEM and MRI demonstrated 100% sensitivity, significantly higher than MG (80%).
- CEM and MRI had statistically higher NPVs than MG.
- CEM showed a significantly lower false-positive rate (33%) compared to MRI (66%).
- MG had the highest false-negative rate, missing 19% of malignant lesions.
Conclusions:
- CEM exhibits diagnostic performance comparable to MRI.
- CEM demonstrates superior sensitivity and NPV compared to standard mammography.
- CEM presents a valuable alternative with improved accuracy and reduced false positives over MG.
Objective:
To compare the diagnostic performance of contrast-enhanced mammography (CEM) with MRI and mammography (MG) based on histopathological results.
Methods:
In this IRB-approved study, written informed consent was obtained from all patients. Images from 40 patients (62 lesions) with suspicious findings on US between March 2018 and August 2018 were evaluated. Sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CEM, MRI, and MG were evaluated and compared within a 95% confidence interval. Maximum dimensions of lesions were measured and correlations of results were evaluated with Spearman's Rho test.
Results:
In the histopathological analysis, 66% (41/62) of lesions were malignant and 34% (21/62) of lesions were benign. Contrast-enhanced mammography, MRI, and MG had sensitivities of 100% (41/41), 100% (41/41), and 80% (33/41), respectively. The sensitivity of CEM and MRI was significantly better than that of MG (P = 0.03). The NPVs of CEM (100%, 7/7) and MRI (100%, 14/14) were statistically higher than the NPV of MG (60%, 12/20) (P = 0.03). The false-positive rates for CEM, MRI, and MG were 33% (7/21), 66% (14/21), and 42% (9/21), respectively. Contrast-enhanced mammography had a significantly lower false-positive rate than MRI (P < 0.001). Mammography had the highest false-negative rate, missing 19% (8/41) of malignant lesions.
Conclusion:
Contrast-enhanced mammography has similar performance characteristics to MRI and improved performance characteristics relative to MG. In particular, CEM and MRI have similar sensitivity and NPVs and both are superior in each of these metrics to MG.
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