Contrast-enhanced spectral mammography improves post-op cancer screening

Contrast-enhanced spectral mammography (CESM) can be a helpful method to screen for postoperative breast cancer when paired with traditional mammography, according to research published July 6 in Clinical Radiology.

“The low-energy image elicited at contrast-enhanced spectral mammography (CESM) is comparable to a regular mammogram, and when combined with the high-energy image, the enhancing structures within the breast tissue can be detected easily,” wrote M. H. Helal, with Cairo University’s Department of Radiology, and colleagues. “CESM may aid in minimizing cases with positive margins (i.e., cancer cells found in the margins of the excised specimen) at the operative bed and in detecting tumor recurrence.”

Helal and colleagues performed low (22-33 kVp) and high (44-49 kVp) energy CESM after intravenous injection of contrast agent in 76 women who had surgery for breast cancer. Their goal was to assess the role of CESM in identifying malignancy in patients with prior breast cancer, specifically in differentiating between benign interventional complications and early local/regional recurrence of cancer.

Histopathology of the “Tru-Cut” biopsy was used as reference standard. Surgical biopsy was used in cases of suspected malignancy and absence of abnormality at follow-up session in benign cases.

Seventy cases were deemed eligible for inclusion; malignancy was found in 48.6% of those cases and enhancement at the operative bed was found in 40 lesions.

Traditional mammography led to a false diagnosis in 17/70 lesions and false positive in 28/70. The modality resulted in a low sensitivity of 50%, specificity of 22%, positive predictive value of 37.7%, negative predictive value of 32% and an accuracy of 35.7%.

When CESM was added to mammography, the combination produced a sensitivity of 91.2%, specificity of 75%, a positive predictive value of 77.5%, negative predictive value of 90% and an accuracy of 82.9%.

“In conclusion, CESM is a credible technique that could be used in conjunction with the traditional mammogram to screen for cancer in the postoperative breast,” the researchers wrote.