Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 12/2022

Open Access 05-07-2022 | Breast Cancer | Breast

Impact of contrast-enhanced mammography in surgical management of breast cancers for women with dense breasts: a dual-center, multi-disciplinary study in Asia

Authors: Yonggeng Goh, Chen-Pin Chou, Ching Wan Chan, Shaik Ahmad Buhari, Mikael Hartman, Siau Wei Tang, Celene Wei Qi Ng, Premilla Pillay, Wynne Chua, Pooja Jagmohan, Eide Sterling, Ying Mei Wong, Loon Ying Tan, Han Yang Ong, Huay-Ben Pan, Herng-Sheng Lee, Bao-Hui Hung, Swee Tian Quek

Published in: European Radiology | Issue 12/2022

Login to get access

Abstract

Objective

To evaluate the impact of pre-operative contrast-enhanced mammography (CEM) in breast cancer patients with dense breasts.

Methods

We conducted a retrospective review of 232 histologically proven breast cancers in 200 women (mean age: 53.4 years ± 10.2) who underwent pre-surgical CEM imaging across two Asian institutions (Singapore and Taiwan). Majority (95.5%) of patients had dense breast tissue (BI-RADS category C or D). Surgical decision was recorded in a simulated blinded multi-disciplinary team setting on two separate scenarios: (i) pre-CEM setting with standard imaging, and clinical and histopathological results; and (ii) post-CEM setting with new imaging and corresponding histological findings from CEM. Alterations in surgical plan (if any) because of CEM imaging were recorded. Predictors CEM of patients who benefitted from surgical plan alterations were evaluated using logistic regression.

Results

CEM resulted in altered surgical plans in 36 (18%) of 200 patients in this study. CEM discovered clinically significant larger tumor size or extent in 24 (12%) patients and additional tumors in 12 (6%) patients. CEM also detected additional benign/false-positive lesions in 13 (6.5%) of the 200 patients. Significant predictors of patients who benefitted from surgical alterations found on multivariate analysis were pre-CEM surgical decision for upfront breast conservation (OR, 7.7; 95% CI, 1.9-32.1; p = 0.005), architectural distortion on mammograms (OR, 7.6; 95% CI, 1.3–42.9; p = .022), and tumor size of ≥ 1.5 cm (OR, 1.5; 95% CI, 1.0-2.2; p = .034).

Conclusion

CEM is an effective imaging technique for pre-surgical planning for Asian breast cancer patients with dense breasts.

Key Points

• CEM significantly altered surgical plans in 18% (nearly 1 in 5) of this Asian study cohort with dense breasts.
• Significant patient and imaging predictors for surgical plan alteration include (i) patients considered for upfront breast-conserving surgery; (ii) architectural distortion lesions; and (iii) tumor size of ≥ 1.5 cm.
• Additional false-positive/benign lesions detected through CEM were uncommon, affecting only 6.5% of the study cohort.
Literature
1.
Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst MM (2015) Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients. BMJ 351:h4901CrossRefPubMedPubMedCentral
2.
Stein RG, Wollschlager D, Kreienberg R et al (2016) The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients. BMC Cancer 16:459CrossRefPubMedPubMedCentral
3.
Hieken TJ, Harrison J, Herreros J, Velasco JM (2001) Correlating sonography, mammography, and pathology in the assessment of breast cancer size. Am J Surg 182(4):351–354
4.
Braun M, Polcher M, Schrading S et al (2008) Influence of preoperative MRI on the surgical management of patients with operable breast cancer. Breast Cancer Res Treat 111(1):179–187CrossRefPubMed
5.
Obdeijn IM, Tilanus-Linthorst MM, Spronk S et al (2013) Preoperative breast MRI can reduce the rate of tumor-positive resection margins and reoperations in patients undergoing breast-conserving surgery. AJR Am J Roentgenol 200(2):304–310CrossRefPubMed
6.
Sung JS, Li J, Da Costa G et al (2014) Preoperative breast MRI for early-stage breast cancer: effect on surgical and long-term outcomes. AJR Am J Roentgenol 202(6):1376–1382CrossRefPubMed
7.
Wang SY, Virnig BA, Tuttle TM, Jacobs DR Jr, Kuntz KM, Kane RL (2013) Variability of preoperative breast MRI utilization among older women with newly diagnosed early-stage breast cancer. Breast J 19(6):627–636CrossRefPubMed
8.
Li L, Roth R, Germaine P et al (2017) Contrast-enhanced spectral mammography (CESM) versus breast magnetic resonance imaging (MRI): a retrospective comparison in 66 breast lesions. Diagn Interv Imaging 98(2):113–123CrossRefPubMed
9.
Patel BK, Hilal T, Covington M et al (2018) Contrast-enhanced spectral mammography is comparable to MRI in the assessment of residual breast cancer following neoadjuvant systemic therapy. Ann Surg Oncol 25(5):1350–1356CrossRefPubMed
10.
Phillips J, Miller MM, Mehta TS et al (2017) Contrast-enhanced spectral mammography (CESM) versus MRI in the high-risk screening setting: patient preferences and attitudes. Clin Imaging 42:193–197CrossRefPubMed
11.
Jochelson MS, Dershaw DD, Sung JS et al (2013) Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology 266(3):743–751CrossRefPubMed
12.
Lee-Felker SA, Tekchandani L, Thomas M et al (2017) Newly diagnosed breast cancer: comparison of contrast-enhanced spectral mammography and breast MR imaging in the evaluation of extent of disease. Radiology 285(2):389–400CrossRefPubMed
13.
Ahsberg K, Gardfjell A, Nimeus E et al (2020) Added value of contrast-enhanced mammography (CEM) in staging of malignant breast lesions-a feasibility study. World J Surg Oncol 18(1):100CrossRefPubMedPubMedCentral
14.
Ali-Mucheru M, Pockaj B, Patel B et al (2016) Contrast-enhanced digital mammography in the surgical management of breast cancer. Ann Surg Oncol 23(Suppl 5):649–655CrossRefPubMed
15.
Amato F, Bicchierai G, Cirone D et al (2019) Preoperative loco-regional staging of invasive lobular carcinoma with contrast-enhanced digital mammography (CEDM). Radiol Med 124(12):1229–1237CrossRefPubMed
16.
Bicchierai G, Tonelli P, Piacenti A et al (2020) Evaluation of contrast-enhanced digital mammography (CEDM) in the preoperative staging of breast cancer: large-scale single-center experience. Breast J 26(7):1276–1283CrossRefPubMed
17.
Girometti R, Linda A, Conte P et al (2021) Multireader comparison of contrast-enhanced mammography versus the combination of digital mammography and digital breast tomosynthesis in the preoperative assessment of breast cancer. Radiol Med 126(11):1407–1414CrossRefPubMed
18.
Rajaram N, Mariapun S, Eriksson M et al (2017) Differences in mammographic density between Asian and Caucasian populations: a comparative analysis. Breast Cancer Res Treat 161(2):353–362CrossRefPubMed
19.
Choi KS, Yoon M, Song SH et al (2018) Effect of mammography screening on stage at breast cancer diagnosis: results from the Korea National Cancer Screening Program. Sci Rep 8(1):8882CrossRefPubMedPubMedCentral
20.
21.
Cheung YC, Juan YH, Lo YF, Lin YC, Yeh CH, Ueng SH (2020) Preoperative assessment of contrast-enhanced spectral mammography of diagnosed breast cancers after sonographic biopsy: correlation to contrast-enhanced magnetic resonance imaging and 5-year postoperative follow-up. Medicine (Baltimore) 99(5):e19024CrossRefPubMed
22.
Kim EY, Youn I, Lee KH et al (2018) Diagnostic value of contrast-enhanced digital mammography versus contrast-enhanced magnetic resonance imaging for the preoperative evaluation of breast cancer. J Breast Cancer 21(4):453–462CrossRefPubMedPubMedCentral
23.
Chou CP, Lewin JM, Chiang CL et al (2015) Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis--comparison to contrast-enhanced breast MRI. Eur J Radiol 84(12):2501–2508CrossRefPubMed
24.
Berg WA, Gutierrez L, NessAiver MS et al (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233(3):830–849CrossRefPubMed
25.
Goldhirsch A, Glick JH, Gelber RD et al (2005) Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 16(10):1569–1583CrossRefPubMed
26.
Gradishar WJ, Anderson BO, Balassanian R et al (2018) Breast cancer, version 4.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 16(3):310–320CrossRefPubMed
27.
Wongpakaran N, Wongpakaran T, Wedding D, Gwet KL (2013) A comparison of Cohen’s kappa and Gwet’s AC1 when calculating inter-rater reliability coefficients: a study conducted with personality disorder samples. BMC Med Res Methodol 13:61CrossRefPubMedPubMedCentral
28.
Houvenaeghel G, Goncalves A, Classe JM et al (2014) Characteristics and clinical outcome of T1 breast cancer: a multicenter retrospective cohort study. Ann Oncol 25(3):623–628CrossRefPubMedPubMedCentral
29.
Fracheboud J, Otto SJ, van Dijck JA et al (2004) Decreased rates of advanced breast cancer due to mammography screening in The Netherlands. Br J Cancer 91(5):861–867CrossRefPubMedPubMedCentral
30.
Goh Y, Chan CW, Pillay P et al (2021) Architecture distortion score (ADS) in malignancy risk stratification of architecture distortion on contrast-enhanced digital mammography. Eur Radiol 31(5):2657–2666CrossRefPubMed
31.
Heil J, Buehler A, Golatta M et al (2012) Do patients with invasive lobular breast cancer benefit in terms of adequate change in surgical therapy from a supplementary preoperative breast MRI? Ann Oncol 23(1):98–104CrossRefPubMed
32.
Lopez JK, Bassett LW (2009) Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics 29(1):165–176CrossRefPubMed
33.
Park YH, Senkus-Konefka E, Im SA et al (2020) Pan-Asian adapted ESMO clinical practice guidelines for the management of patients with early breast cancer: a KSMO-ESMO initiative endorsed by CSCO, ISMPO, JSMO, MOS, SSO and TOS. Ann Oncol 31(4):451–469CrossRefPubMed
34.
Sorin V, Yagil Y, Yosepovich A et al (2018) Contrast-enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. AJR Am J Roentgenol 211(5):W267–W274CrossRefPubMed
Metadata
Title
Impact of contrast-enhanced mammography in surgical management of breast cancers for women with dense breasts: a dual-center, multi-disciplinary study in Asia
Authors
Yonggeng Goh
Chen-Pin Chou
Ching Wan Chan
Shaik Ahmad Buhari
Mikael Hartman
Siau Wei Tang
Celene Wei Qi Ng
Premilla Pillay
Wynne Chua
Pooja Jagmohan
Eide Sterling
Ying Mei Wong
Loon Ying Tan
Han Yang Ong
Huay-Ben Pan
Herng-Sheng Lee
Bao-Hui Hung
Swee Tian Quek
Publication date
05-07-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08906-0

Other articles of this Issue 12/2022

European Radiology 12/2022 Go to the issue

Oncology

A systematic review of prognosis predictive role of radiomics in pancreatic cancer: heterogeneity markers or statistical tricks?

Imaging Informatics and Artificial Intelligence

Using deep learning to safely exclude lesions with only ultrafast breast MRI to shorten acquisition and reading time

Musculoskeletal

Tibial tubercle-Roman arch (TT-RA) distance is superior to tibial tubercle-trochlear groove (TT-TG) distance when evaluating coronal malalignment in patients with knee osteoarthritis

Computed Tomography

Ureteral calculi lithotripsy for single ureteral calculi: can DNN-assisted model help preoperatively predict risk factors for sepsis?

Gastrointestinal

Development and validation of an ultrasound-based prediction model for differentiating between malignant and benign solid pancreatic lesions

Chest

Can deep learning improve image quality of low-dose CT: a prospective study in interstitial lung disease