The role of contrast-enhanced spectral mammography in the evaluation of the postoperative breast cancer

Authors: M.H. Helala, S.M. Mansourb,'Correspondence information about the author S.M. MansourEmail the author S.M. Mansour, H.A. Ahmedc, A.F. Abdel Ghanyc, O.F. Kamelc, N.G. Elkholyd

•Post operative benign sequels are often a dilemma at mammograms that could mimic malignancy and ultrasound may not help.
•Contrast enhanced spectral mammogram is a contrast-based new application.
•The different enhancement patterns allow recognizable distinction between the accepted operative changes and malignancy.
To assess the utility of contrast-enhanced spectral mammography (CESM) to detect malignancy in the postoperative breast of cancer patients.

The study was a prospective analysis of 76 women following operations for breast cancer. CESM was performed with low (22–33 kVp) and high (44–49 kVp) energy exposures after intravenous injection of contrast agent. Breast abnormalities were evaluated regarding the presence, morphology, and pattern of contrast medium uptake. The reference standard was histopathology of the Tru-Cut biopsy or surgical biopsy in cases where malignancy was suspected and absence of abnormality at follow-up sessions in benign cases.

Seventy cases were eligible for data analysis, and malignancy was detected in 48.6% (n=34/70). Enhancement at the operative bed was observed in 40 (57.14%) lesions. At traditional mammography, the diagnosis was false negative in 17/70 and false positive in 28/70 lesions, and presented a low sensitivity of 50%, a very low specificity of 22%, a positive predictive value of 37.7%, a negative predicative value of 32%, and an accuracy of 35.7%. CESM enhanced the performance of mammography and produced a sensitivity of 91.17%, a specificity of 75%, a positive predictive value of 77.5%, a negative predictive value of 90%, and an accuracy of 82.85%.

CESM is a credible technique that could be used in conjunction with the traditional mammogram to screen for cancer in the postoperative breast.