Dual energy contrast enhanced digital mammography: Technique, indications and comparison with magnetic resonance imaging/mammography

OBJECTIVE The purpose of this study was to compare diagnostic performance of contrast enhanced digital mammography (CEDM), contrast enhanced magnetic resonance imaging (MRI) and digital mammography (MG) according to histopathological findings in 40 women with suspicion of breast cancer. MATERIALS AND METHODS Images from 40 patients with suspicious findings in clinic, ultrasonographic or mammographic images between March and August of 2018 is evaluated retrospectively. All of the patients were newly diagnosed and 62 lesions were detected in total. Sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and accuracy of CESM, MRI, MG was investigated and compared. Malign and high risk precursor lesions were accepted as positive result and benign lesions were accepted as negative result in statistical analysis. Histopathological results were accepted as the gold standart. Maximum dimesions of 62 lesions measured and correlations of this results evaluated with Spearman's Rho test. Approval from ethics commitee and written informed consent from every patients were taken before the study. RESULTS 62 lesions with malignity suspicion were detected in 40 women. Among the 62 lesions, 55 lesions(88.7%) can be detected with MRI , 48 lesions(77.4%) can be detected with CESM and 42 lesions(67.7%) can be detected by MG. In histopathological analysis, 41 of 62 lesions(66.1%) were malign, 21 lesions(33.9%) were benign. 24 of 41 malign lesions(58.5%) were diagnosed as invasive ductal carcinoma. 10 of 21 benign lesions(47.6%) were diagnosed as fibrocystic changes. CEDM and MRI had a sensitivity of 100%. MG had a sensitivity of 80% and sensitivity was significantly better with CESM and MRI than with MG. CEDM had a specificity of %66 , MRI had a specificity of %33 and MG had a specificity of %57. Specificity of CEDM was higher than orther modlities but this difference was not statistically significant. PPV was %85 with CEDM , %74 with MRI and 78.6% for MG. The PPV of CEDM was higher than others but there was not significant difference statistically. The accuracy was %88 with CEDM, %77 with MRI and %72 with MG. The accuracy of CEDM was higher than other modalities but there was not significant difference statistically. The NPV of CEDM and MRI was 100% and higher than the 60% NPV of MG. MRI had the highest false positivity rate with 66%(14 lesions) false positivity rate of MG was 42%(9 lesions) and of CEDM 33%(7 lesions). MG had the highest false negativity rate (%24) by missing 8 malign lesions. CONCLUSION CEDM is a current modality giving information about morphology and perfusion characteristics of the breast lesions like MRI. CEDM has similiar sensitivity, better PPV and lower false positivity comparing to MRI. Also, CEDM has an advantage in cost and shorter examination relative to MRI. Integration of CEDM to diagnostic breast imaging and usage in patients with contraindications to MRI can be possible. CEDM may be valuable as an alternative screening test for yearly MRI and MG combination in high risk patients.