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16-01-2024 | Mammography | Breast

Current use and future perspectives of contrast-enhanced mammography (CEM): a survey by the European Society of Breast Imaging (EUSOBI)

Authors: Simone Schiaffino, Andrea Cozzi, Paola Clauser, Elisabetta Giannotti, Maria Adele Marino, Thiemo J. A. van Nijnatten, Pascal A. T. Baltzer, Marc B. I. Lobbes, Ritse M. Mann, Katja Pinker, Michael H. Fuchsjäger, Ruud M. Pijnappel, on behalf of the European Society of Breast Imaging (EUSOBI)

Published in: European Radiology

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Abstract

Objectives

To perform a survey among members of the European Society of Breast Imaging (EUSOBI) regarding the use of contrast-enhanced mammography (CEM).

Methods

A panel of nine board-certified radiologists developed a 29-item online questionnaire, distributed to all EUSOBI members (inside and outside Europe) from January 25 to March 10, 2023. CEM implementation, examination protocols, reporting strategies, and current and future CEM indications were investigated. Replies were exploratively analyzed with descriptive and non-parametric statistics.

Results

Among 434 respondents (74.9% from Europe), 50% (217/434) declared to use CEM, 155/217 (71.4%) seeing less than 200 CEMs per year. CEM use was associated with academic settings and high breast imaging workload (< 0.001). The lack of CEM adoption was most commonly due to the perceived absence of a clinical need (65.0%) and the lack of resources to acquire CEM-capable systems (37.3%). CEM protocols varied widely, but most respondents (61.3%) had already adopted the 2022 ACR CEM BI-RADS® lexicon. CEM use in patients with contraindications to MRI was the most common current indication (80.6%), followed by preoperative staging (68.7%). Patients with MRI contraindications also represented the most commonly foreseen CEM indication (88.0%), followed by the work-up of inconclusive findings at non-contrast examinations (61.5%) and supplemental imaging in dense breasts (53.0%). Respondents declaring CEM use and higher CEM experience gave significantly more current (= 0.004) and future indications (< 0.001).

Conclusions

Despite a trend towards academic high-workload settings and its prevalent use in patients with MRI contraindications, CEM use and progressive experience were associated with increased confidence in the technique.

Clinical relevance statement

In this first survey on contrast-enhanced mammography (CEM) use and perspectives among the European Society of Breast Imaging (EUSOBI) members, the perceived absence of a clinical need chiefly drove the 50% CEM adoption rate. CEM adoption and progressive experience were associated with more extended current and future indications.

Key Points

Among the 434 members of the European Society of Breast Imaging who completed this survey, 50% declared to use contrast-enhanced mammography in clinical practice.
Due to the perceived absence of a clinical need, contrast-enhanced mammography (CEM) is still prevalently used as a replacement for MRI in patients with MRI contraindications.
The number of current and future CEM indications marked by respondents was associated with their degree of CEM experience.
Appendix
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Literature
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35.
go back to reference Lee CH, Phillips J, Sung JS, Lewin JM, Newell MS (2022) ACR BI-RADS® Contrast Enhanced Mammography (CEM). In: ACRs BI-RADS® Atlas. Breast Imaging Reporting and Data System, American College of Radiology, pp 1–64 Lee CH, Phillips J, Sung JS, Lewin JM, Newell MS (2022) ACR BI-RADS® Contrast Enhanced Mammography (CEM). In: ACRs BI-RADS® Atlas. Breast Imaging Reporting and Data System, American College of Radiology, pp 1–64
Metadata
Title
Current use and future perspectives of contrast-enhanced mammography (CEM): a survey by the European Society of Breast Imaging (EUSOBI)
Authors
Simone Schiaffino
Andrea Cozzi
Paola Clauser
Elisabetta Giannotti
Maria Adele Marino
Thiemo J. A. van Nijnatten
Pascal A. T. Baltzer
Marc B. I. Lobbes
Ritse M. Mann
Katja Pinker
Michael H. Fuchsjäger
Ruud M. Pijnappel
on behalf of the European Society of Breast Imaging (EUSOBI)
Publication date
16-01-2024
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-10574-7