Added value of contrast-enhanced mammography in assessment of breast asymmetries

Objective: To evaluate the clinical performance of contrast-enhanced spectral mammography (CESM) on asymmetries detected on a mammogram (MG). Methods: This study was approved by the Scientific Research Review Board of the Radiology Department, and waiver of informed consent was applied for the uses of data of the included cases. The study included 125 female patients, 33 (26.4%) who presented for screening and 92 (73.6%) who presented for a diagnostic MG. All had breast asymmetries on MG. Ultrasound examination and CESM using dual-energy acquisitions were performed for all patients. Results: In all, 88/125 (70.4%) females had focal asymmetry (seen in two views and occupying less than a quadrant), 26/125 (20.8%) had global asymmetry (occupying more than one quadrant), 10/125 (8%) had asymmetry (seen in a single view and occupying less than a quadrant), and 1/125 had developing asymmetry (0.8%) (not present in the previous MG). Malignant lesions represented 91 cases, benign lesions represented 30 cases, and 4 cases were high-risk lesions. CESM sensitivity was 100% (vs 97.8 % for sono-mammography), specificity was 55.88% (vs 81.8% for sono-mammography), and the positive- and negative-predictive values were 85.85 and 100% (vs 93.7 and 93% for sono-mammography respectively). Conclusion: In our study, we conclude that focal and global asymmetries with other suspicious mammographic findings were statistically significant for malignancy and CESM played an important role in delineating tumor size and extension. Any non-enhancing asymmetrical density correlated with a benign pathology, if not associated with other suspicious imaging findings. Advances in knowledge: Our study is the first to explore the added value of CESM to asymmetries detected in screening and diagnostic mammography.