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Open Access

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

  • Sarah Tennant1,
  • Eleanor Cornford1,
  • Jonathan James1,
  • Helen Burrell1,
  • Lisa Hamilton1 and
  • Yan Chen2
Breast Cancer Research201517(Suppl 1):P14

Published: 5 November 2015


Dual EnergySymptomatic BreastClinical AbnormalityContrast UptakeGood Size


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.


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.


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).


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.

Authors’ Affiliations

Nottingham University Hospitals NHS Trust, Nottingham, UK
Loughborough University, Leicester, UK


© Tennant et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.