CESM provides value during postoperative breast cancer screening

Contrast-enhanced spectral mammography (CESM) can assist proiders with the postoperative screening of breast cancer patients, according to research published in Clinical Radiology.

“Scanning of the postoperative breast represents an imaging dilemma as there is an overlap between the features of accepted benign post-treatment alterations and pre-existing cancer,” wrote M.H. Helal, National Cancer Institute in Cairo, Egypt, and colleagues. “After lumpectomy and radiation therapy, changes such as seromas, breast oedema, dermal thickening, focal distortion, and calcifications, are not easily discriminated from recurrent breast carcinoma and this could lead to unnecessary recall on screening.”

The authors tracked data from 70 patients who had “suspicious abnormalities of the postoperative breast” detected during a preliminary mammogram. All patients were treated from May 2015 to October 2017 at a single institute. CESM was performed with low (22-33 kVp) and high (44-49 kVp) energy exposures.

Overall, 48.6% of cases detected a malignancy. After just traditional mammography, there were 17 false-negative cases, 28 false-positive cases, a sensitivity of 50%, a specificity of just 22%, a positive predictive value (PPV) of 37.7%, a negative predictive value (NPV) of 32% and an accuracy of 35.7%. With CESM enhancing the performance of the mammogram, sensitivity was 91.17%, specificity was 75%, PPV was 77.5%, NPV was 90% and accuracy was 82.85%.

Helal et al. noted that a patient’s long-term survival can be “dramatically improved” when the local recurrence of breast cancer is detected early on. CESM, according to their findings, can provide value by assisting with the treatment of findings that may represent recurrent cancers.

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