Using Contrast Agent-Enhanced Digital Mammography in Women at Higher Risk of Breast Cancer

Researchers sought to assess the performance of contrast agent-enhanced digital mammography (CEDM) in screening for breast cancer. From December 2012 through April 2016, the researchers included women who went through dual-energy CEDM screening for breast cancer. Age, risk factors, short-interval follow-up, suggested biopsies, and detected cancers were studied through the medical records. Researchers determined sensitivity, specificity, positive predictive value of irregular findings at screening (PPV1), positive predictive value of biopsy performed (PPV3), and negative predictive value.

A total of 904 CEDMs were completed at baseline, and the mean age was 51.8 years ± 9.4 (standard deviation). Approximately 77% of the 904 patients had dense breasts, 27% of patients had a family history of breast cancer from a first-degree relative aged 50 years or younger, and 40% of patients had a personal breast cancer history. Fifteen cancers were diagnosed in 14 out of 904 patients using CEDM, and PPV3 was 29.4% (15 of 51). A 1-year follow-up was performed in 858 women, and there were 2 interval cancers. Sensitivity was 50.0% (8 of 16; 95% confidence interval [CI]: 24.7%, 75.3%) on the low-energy images vs 87.5% (14 of 16; 95% CI: 61.7%, 98.4%) for the whole study (low-energy and iodine images; P= .03). It was found that specificity was 93.7% (789 of 842; 95% CI: 91.8%, 95.2%), and PPV1 was 20.9% (14 of 67; 95% CI: 11.9%, 32.6%). Negative predictive value was 99.7% (789 of 791; 95% CI: 99.09%, 99.97%). The researchers concluded that CEDM shows potential as a screening technique for women who have a higher risk of breast cancer.


Sung JS, Lebron L, Keating D, et al. Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer. Radiology. 2019;293(1):81-88. doi:10.1148/radiol.2019182660

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