Contrast-enhanced digital mammography: a cost-effective substitute for breast MRI?

It’s well established that screening mammography successfully reduces breast cancer incidence and mortality, but in high-risk patients with certain BRCA mutations or dense breasts, other imaging techniques are often used instead. Breast MRI is one modality specialists often turn to in these cases, though it fails to identify calcifications and can be quite expensive to use.

This is where contrast-enhanced digital mammography (CEDM) comes in. According to a recent analysis published in the American Journal of Roentgenology, CEDM is a cost-effective modality that works well as an alternative to breast MRI.

“CEDM is the newest contrast-enhanced technology for breast imaging and holds great promise for addressing clinical indications similar to those of breast MRI while also addressing its potential limitations,” wrote Bhavika K. Patel, MD, department of radiology at the Mayo Clinic Hospital in Phoenix, and colleagues. “CEDM generates a high-resolution, low-energy, full-field digital mammography (FFDM) image and, as does MRI, a contrast-enhanced image that provides information on lesion vascularity.”

The authors explored the effectiveness of CEDM from numerous angles. Considering the required equipment, for instance, they explained that installation is “straightforward.” “Existing mammographic equipment can be modified with relative ease to enable CEDM, possibly increasing patient access to contrast-enhanced breast imaging at minimal incremental cost while improving clinical resource efficiency,” they wrote.

Examining the efficacy of CEDM, the authors noted that some studies have indicated that CEDM has lower false-positive rates than breast MRI. In addition, they cited a specific study that revealed “statistically significant improvement in microcalcification visualization on low-energy CEDM images” when compared with FFDM. 

“This suggests that CEDM could increase diagnostic accuracy for ductal carcinoma in situ because the low-energy images may capture the extent of disease more effectively than does MRI,” the authors wrote.

Patel et al. also compared the cost-effectiveness of CEDM and breast MRI, finding CEDM to be significantly less expensive. One reason for this is that breast MRI patients also undergo FFDM, but that additional screening is not necessary when patients undergo CEDM. Also, breast MRI takes much longer than CEDM, which negatively impacts the facility’s bottom line.

“When the American Cancer Society issued screening MRI guidelines in 2007, it was estimated that as many as 1.4 million women would qualify for breast MRI screening,” the authors wrote. “If CEDM were deemed a viable substitute for breast MRI, at current Current Procedural Terminology codes and Medicare reimbursement rates, the savings would be approximately $750 per examination and as much as $1.1 billion annually. If only a portion of the women in the breast MRI screening population were to qualify for CEDM, there would still be the potential for substantial efficiencies.”