Contrast Enhanced Spectral Mammography; How to Manage the Findings

Purpose: Our aim was to learn what is the clinical workup of Contrast Enhanced Spectral Mammography (CEM) detected lesions.

Material and methods: This was a retrospective, single-center study. The analysis included all CEM examinations performed in our institution between 2016 and 2020. CEM BPE and CEM findings were assessed according to the MRI criteria of the Breast Imaging Reporting and Data System. Patient demographics, pathology results, were all retrieved from the digital patient records.

Results: Our study included CEM studies of 240 patients. 277 workups composed of 160 mass and 37 non mass like lesions, 2 lesions of both mass and non-mass like enhancement as well as 78 CEM studies with no findings. 184 Out of 199 mass and non-mass lesions (92%) were detected on tomosynthesis and 153/199 (77%) on ultrasound. MRI evaluation was required in 7 lesions, which was performed in a biopsy setup, so the evaluation could be performed at the same visit. 29/39 (74%) of the additional biopsies performed for additional lesions were IDC, ILC or DCIS. Lesion size measured on CEM correlated with the actual tumor size as reported on the surgical pathology (r=0.75 p<0.0001). As opposed to MRI, marked BPE, which could reduce study sensitivity, was found only in 10% of cases. We found no association to lesion type (mass or non-mass), or lesions size to the likelihood of being detected by tomosynthesis or US.

Conclusion: In the clinical workup of CEM, tomosynthesis and US play a substantial role, and our study results support their routine use when performing CEM. MRI biopsy capabilities will aid in a small number of lesions otherwise not detected.