Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis—Comparison to contrast-enhanced breast MRI

• The overall sensitivity of contrast-enhanced digital mammography (CEDM) ranged from 93% to 98% for three readers, versus 93% to 99% for contrast-enhanced tomosynthesis (CET) and 86% to 93% for dynamic contrast-enhanced breast MRI (DCE-MRI).
• All three contrast-enhanced modalities (CEDM, CET, DCE-MRI) were superior in both sensitivity and AUC to conventional (non-contrast) digital mammography and tomosynthesis.
• Contrast-enhanced digital mammographic images, with or without contrast-enhanced tomosynthesis, is equivalent in diagnostic performance to dynamic contrast-enhanced breast MRI in breast cancers.

PurposeTo compare the diagnostic accuracy of contrast-enhanced digital mammography (CEDM) and contrast-enhanced tomosynthesis (CET) to dynamic contrast enhanced breast MRI (DCE-MRI) using a multireader-multicase study.MethodsInstitutional review board approval and informed consents were obtained. Total 185 patients (mean age 51.3) with BI-RADS 4 or 5 lesions were evaluated before biopsy with mammography, tomosynthesis, CEDM, CET and DCE-MRI. Mediolateral-oblique and cranio-caudal views of the target breast CEDM and CET were acquired at 2 and 4 min after contrast agent injection. A mediolateral-oblique view of the non-target breast was taken at 6 min. Each lesion was scored with forced BI-RADS categories by three readers. Each reader interpreted lesions in the following order: mammography, tomosynthesis, CEDM, CET, and DCE-MRI during a single reading session.ResultsHistology showed 81 cancers and 144 benign lesions in the study. Of the 81 malignant lesions, 44% (36/81) were invasive and 56% (45/81) were non-invasive. Areas under the ROC curve, averaged for the 3 readers, were as follows: 0.897 for DCE-MRI, 0.892 for CET, 0.878 for CEDM, 0.784 for tomosynthesis and 0.740 for mammography. Significant differences in AUC were found between the group of contrast enhanced modalities (CEDM, CET, DCE-MRI) and the unenhanced modalities (all p < 0.05). No significant differences were found in AUC between DCE-MRI, CET and CEDM (all p > 0.05).ConclusionCET and CEDM may be considered as an alternative modality to MRI for following up women with abnormal mammography. All three contrast modalities were superior in accuracy to conventional digital mammography with or without tomosynthesis.