# Efficacy of Contrast-Enhanced Mammography in the Evaluation of Breast Lesions: An Initial Experience

## TL;DR

Contrast-enhanced mammography effectively detects and characterizes breast lesions, showing high specificity and good sensitivity.

## Contribution

This study provides initial evidence of CEM's efficacy in breast lesion evaluation through a retrospective analysis with histopathology correlation.

## Key findings

- CEM demonstrated 78.6% sensitivity and 100% specificity in characterizing breast lesions.
- Malignant lesions showed enhancement with washout in 55 out of 70 cases.
- All benign lesions showed either enhancement without washout or no enhancement.

## Abstract

Introduction: Contrast-enhanced mammography (CEM) is an emerging technique for evaluating breast lesions. It is practiced in a few centers and is mostly used as a problem-solving tool in clinical practice and for therapeutic planning of breast cancer.

Objectives: This study aimed to evaluate the efficacy of CEM in the detection and characterization of breast lesions.

Methods: We retrospectively evaluated 142 patients (mean age 50 +/- 25 years) who underwent technically successful CEM for the characterization of breast lesions between February 2023 and October 2023. Out of 142 patients, 96 patients (108 lesions) who had histopathology correlation were included for analysis. The patients with no histopathology were excluded. CEM was performed using a Siemens Healthineers Mammomat Revelation machine (Erlangen, Germany). A 1.5 ml/kg body weight of iodinated contrast media (Omnipaque 350, GE Healthcare, Chicago, IL) was intravenously injected at a rate of 3.5 mL/sec. Both low-energy (28-32 kVp) and high-energy (45-49 kVp) images of the cranio-caudal and mediolateral projections were acquired two to eight minutes after injection. Images were analyzed by two breast radiologists on a dedicated workstation (MedMammo (Medecom, Plougastel-Daoulas, France) and BARCO (Barco NV, Kortrijk (Courtrai), Belgium)).

Results: The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CEM for characterizing the breast lesions were 78.6%, 100%, 100%, and 71.7%, respectively. Out of 108 lesions, 70 were malignant and 38 were benign. Among 70 malignant lesions, 55 lesions showed enhancement with washout, and 14 showed only enhancement with no washout. One malignant lesion showed no enhancement. Out of 38 benign lesions, 29 showed enhancement with no washout, and nine did not show enhancement.

Conclusion: CEM showed good sensitivity and specificity in the detection and characterization of breast lesions.