Contrast-enhanced spectral mammography: what is the 'added value' in a symptomatic setting? Initial findings from a UK centre

Introduction

Contrast-enhanced spectral mammography (CESM) is a new technology. Dual energy acquisitions during one exposure yield two sets of images: a low energy (LE) set, equivalent to standard full field digital mammography (FFDM); and a recombined set displaying contrast uptake. In our symptomatic breast service, specific patients, including those with a P4/5 clinical abnormality are offered CESM instead of FFDM. Despite encouraging data from Europe and the USA, there are, until now, no UK data to support its use in this setting.

Methods

Retrospective multi-reader review of 50 consecutive patients undergoing CESM. Anonymised LE images were reviewed and given a score for suspicion of malignancy. At least 3 weeks later, the entire examination (LE and recombined images) was reviewed. Pathology data were obtained for all cases. Differences in performance were assessed using receiver-operative characteristic (ROC) analysis. Sensitivity, specificity and lesion size (vs. MRI or histopathology) were analysed using a two-way independent t test.

Results

Fifty females, mean age 49. Thirty-four (68 %) patients had biopsy-proven malignancy, 16 (32 %) were benign. CESM was more sensitive than LE alone (94 % vs. 86 %, p <0.025), more specific than LE alone (84 % vs. 63 %, p <0.025) and showed better size estimation (mean size difference 23 % vs. 31 %, p <0.025). ROC analysis showed CESM performance was better than LE alone (AUC 0.933 vs. 0.848, p <0.05).

Conclusion

This preliminary study demonstrates the additional clinical utility of CESM in symptomatic patients. Its potential use in other clinical settings (e.g. screening of high-risk women) requires evaluation.