Contrast-enhanced mammography for screening recalls: a problem-solving assessment tool ready for use?

Excerpt

Full-field digital mammography (DM) is the standard technique as of today for breast cancer screening, although digital breast tomosynthesis (DBT) is increasingly used in some countries, especially in the USA. Conventional DM has, however, two important limitations as a screening technique: a low sensitivity in women with dense breast parenchyma due to a masking effect, and a relatively low specificity due to superpositioning causing so-called pseudotumors. Non-conclusive findings at standard two-view mammographic screening need recall and further diagnostic work-up including supplementary mammographic views, ultrasound, digital breast tomosynthesis (DBT), MRI, and/or needle biopsy to confirm or exclude the presence of cancer. Adverse effects of mammography screening include false-negative interpretations causing interval cancer and false positive findings causing unnecessary recalls. Assessments of false-positive screening recalls represent a great problem not only to the women often causing psychologic distress and transient anxiety but also to the health care providers since unnecessary work-up including needle biopsies are expensive and represent a financial burden. Consequently, there is a need for a single diagnostic test with high diagnostic accuracy that could replace the several procedures included in today’s standard work-up for screening recalls. …