CEDM shows promise as breast cancer screening tool for high-risk women

Contrast-enhanced digital mammography (CEDM) could be an effective alternative to full-field digital mammography (FFDM) for screening women at an elevated risk of breast cancer, according to new findings published in Radiology.

The authors explored data from 904 patients who underwent baseline CEDM examinations for breast cancer screening from December 2012 to April 2016. In each instance, CEDM was either specifically ordered by the referring physician or performed for a clinical study. A majority (77.4%) of patients had dense breast tissue, 27.3% had a family history of breast cancer and 40.2% had a personal history with the disease.

Each examination occurred two to three minutes after contrast injection. The final Breast Imaging Reporting and Data System (BI-RADS) score was one or two for 92% of patients. The BI-RADS score was a three for 2.8% of patients and a 4 or 5 for the other 5.2%.

Overall, CEDM helped providers diagnose 15 cancers in 14 patients, a cancer detection rate of 15.5 per 1,000 patients. Also, the contrast enhancement associated with the CEDM examinations helped detect six of the eight cancers that were missed when only low-energy images were being used.

CEDM had greater sensitivity (87.5%) than FFDM (50%) and its specificity was 93.7%.

“Screening CEDM may also be beneficial in women at high risk for breast cancer,” wrote Janice S. Sung, MD, Memorial Sloan Kettering Cancer Center in New York City, and colleagues. “Because of their increased risk of interval cancers, some women with BRCA mutations stagger their screening mammography and MRI at six-month intervals, which may be more effective than stacked screening. CEDM may be an alternative to conventional mammography so that these women undergo a vascular-based screening test every six months.”

Also, while CEDM did lead to more false-positive findings, the numbers were still “comparable to established benchmarks for both mammography and breast MRI,” the authors explained.

The researchers noted that reactions to the contrast agent occurred in 1.7% of the examinations. One patient had a moderate reaction, but all others experienced mild reactions such as hives or feeling nauseous.

Sung et al. added that their research did include certain limitations. This was a single-institution study, for instance, and the study cohort “was composed largely of women with dense breasts and increased breast cancer risk.”

“The performance of CEDM in women with non-dense breasts and/or average breast cancer risk may be different,” the authors wrote.