Advertisement

Accuracy of contrast-enhanced spectral mammography compared with MRI for invasive breast cancers: Prospective study in population of predominantly underrepresented minorities

  • Sandy C. Lee
    Correspondence
    Corresponding author at: Department of Radiology, Keck School of Medicine, University of Southern California, LAC General Hospital, 1200 North State Street, 3rd Floor Suite 3750A, Los Angeles, CA 90033, United States of America.
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America
    Search for articles by this author
  • Linda Hovanessian-Larsen
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America
    Search for articles by this author
  • Daniel Stahl
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America
    Search for articles by this author
  • Steven Cen
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America
    Search for articles by this author
  • Xiaomeng Lei
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America
    Search for articles by this author
  • Bhushan Desai
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America
    Search for articles by this author
  • Mary Yamashita
    Affiliations
    Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America
    Search for articles by this author

      Highlights

      • CESM is as effective as MRI in evaluating index cancers and additional disease.
      • CESM has comparable sensitivity and better specificity than MRI.
      • Prospective study shows CESM is useful modality in underrepresented minority patients.

      Abstract

      Objectives

      This prospective study compares contrast-enhanced spectral mammography (CESM) with contrast-enhanced breast MRI in assessing the extent of newly diagnosed breast cancer in a multiethnic cohort.

      Methods

      This study includes 41 patients with invasive breast cancer detected by mammography or conventional ultrasound imaging from May 2017 to March 2020. CESM and MRI scans were performed prior to any treatment. Results are compared with each other and to histopathology. Detection of the malignant lesion was assessed by sensitivity, specificity, PPV, NPV. Consistency of malignant tumor size measurement was compared between modalities using Intraclass Correlation Coefficient (ICC).

      Results

      In a multiethnic cohort with over 65% Hispanic and African-American women, the sensitivity of detecting malignant lesions for CESM is 93.1% (77.23%, 99.15%) and MRI is 96.55% (82.24%, 99.91%). The PPV for CESM 96.43% (81.65%, 99.91%) is better compared to MRI 82.35% (65.47%, 93.24%). CESM is as effective as MRI in evaluating index cancers and multifocal/multicentric/contralateral disease. CESM has greater specificity and PPV since MRI tends to overcall benign lesions. There is a good agreement of tumor size between CESM to surgery and MRI to surgery with ICC of 0.85 (95% CI 0.69, 0.93) and 0.87 (95% CI 0.74, 0.94), respectively. There is good agreement of malignancy detection between CESM and MRI with Kappa of 0.74 (95% CI 0.52, 0.95).

      Conclusions

      CESM is an effective imaging modality for evaluating the extent of disease in newly diagnosed invasive breast cancers and a good alternative to MRI in a multiethnic population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; https://gis.cdc.gov/Cancer/USCS/DataViz.html (Accessed December 2020).

        • Yedjou C.G.
        • Sims J.N.
        • Miele L.
        • et al.
        Health and racial disparity in breast cancer.
        Adv Exp Med Biol. 2019; 1152: 31-49
        • Chen L.
        • Li C.
        Racial disparities in breast cancer diagnosis and treatment by hormone receptor and HER2 status.
        Cancer Epidemiol Biomarkers Prev. 2015; 24: 1666-1672
        • Mootz A.
        • Arjmandi F.
        • Dogan B.E.
        • et al.
        Health care disparities in breast cancer: the economics of access to screening, diagnosis, and treatment.
        J Breast Imaging. 2020; 2: 524-529
        • Champion C.D.
        • Thomas S.M.
        • Plichta J.K.
        • et al.
        Disparities at the intersection of race and ethnicity: examining trends and outcomes in hispanic women with breast cancer.
        JCO Oncol Pract. 2020; 0: 0
        • United States Census Bureau
        • James J.J.
        • Tennant S.L.
        Contrast-enhanced spectral mammography (CESM).
        Clin Radiol. 2018; 73: 715-723
        • Skanne P.
        • Bandos A.I.
        • Gullien R.
        • et al.
        Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program.
        Radiology. 2013 April; 267: 47-56
        • Ciatto S.
        • Houssami N.
        • Bernardi D.
        • et al.
        Integration of 3D digital mammography with tomosynthesis for population breast cancer screening.
        Lancet Oncology. 2013 June; 14: 583-589
        • Rose S.L.
        • Tidwell A.L.
        • Bujnoch L.J.
        • et al.
        Implementation of breast tomosynthesis in a routine screening practice.
        Am J Roentgenol. 2013 June; 200: 1401-1408
        • Bedrosian I.
        • Mick R.
        • Orel S.
        • et al.
        Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging.
        Cancer. 2003; 98: 468-473
        • Plana M.N.
        • Carreira C.
        • Muriel A.
        • et al.
        Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer; systematic review of diagnostic accuracy and meta-analysis.
        Euro Radiology. 2012; 22: 26-38
        • Houssami N.
        • Ciatto S.
        • Macaskill P.
        • et al.
        Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer.
        J Clin Oncol. 2008; 26: 3248-3258
        • Waite S.
        • Scott J.
        • Colombo D.
        Narrowing the gap: imaging disparities in radiology.
        Radiology. 2021; 299: 27-35
        • Zhu Huang J.M.
        • Zhang K.
        • et al.
        Diagnostic value of contrast-enhanced spectral mammography for screening breast cancer: systematic review and meta-analysis.
        Clin Breast Cancer. 2018; 18: 985-995
        • Patel B.K.
        • Gray R.J.
        • Pockaj B.A.
        • et al.
        Potential cost Savings of Contrast-Enhanced Digital Mammography.
        Am J Roentgenol. 2017; 208: 231-237
        • Hobbs M.M.
        • Taylor D.B.
        • Buzynski S.
        • et al.
        Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): patient preferences and tolerance.
        J Med Imaging Radiat Oncol. 2015; 59: 300-305
        • Byrt T.
        • Bishop J.
        • Carlin J.B.
        Bias, prevalence and kappa.
        J Clin Epidemiol. 1993; 46: 423-429
        • Mak H.
        • Yau K.
        • Chan B.
        Prevalence-adjusted bias adjusted k values as additional indicators to measure observer agreement [letter].
        Radiology. 2004; 232: 302-303
        • Kanda T.
        • Ishii K.
        • Kawaguchi H.
        • et al.
        High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material.
        Radiology. 2014; 270: 834-841
        • Sardanelli F.
        • Cozzi A.
        • Trimboli R.M.
        • et al.
        Gadolinium retention and breast MRI screening.
        Am J Roentgenol. 2020; 214: 324-327
        • Bennani-Baiti B.
        • Krug B.
        • Giese D.
        • et al.
        Evaluation of 3.0-T MRI brain signal after exposure to gadoterate meglumine in women with high breast cancer risk and screening breast MRI.
        Radiology. 2019; 293: 523-530
        • Lee-Felker S.A.
        • Tekchandani L.
        • Thomas M.
        • et al.
        Newly diagnosed breast cancer: comparison of contrast-enhanced spectral mammography and breast MR imaging in the evaluation of extent of disease.
        Radiology. 2017; 285: 389-400
        • Xiang W.
        • Rao H.
        • Zhou L.
        A meta-analysis of contrast-enhanced spectral mammography versus MRI in the diagnosis of breast cancer.
        Thorac Cancer. 2020; 11: 1423-1432
        • Jochelson M.S.
        • Dershaw D.D.
        • Sung J.S.
        • et al.
        Bilateral contrast enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma.
        Radiology. 2013; 266: 743-751
        • Bozzini A.
        • Nicosia L.
        • Pruneri G.
        • et al.
        Clinical performance of contrast-enhanced spectral mammography in pre-surgical evaluation of breast malignant lesions in dense breasts: a single center study.
        Breast Cancer Res Treat. 2020; 184: 723-731
        • Xing D.
        • Lv Y.
        • Sun B.
        • et al.
        Diagnostic value of contrast-enhanced spectral mammography in comparison to magnetic resonance imaging in breast lesions.
        J Comput Assist Tomogr. 2019; 43: 245-251
        • Lehman C.D.
        • Gatsonis C.
        • Kuhl C.K.
        • et al.
        MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer.
        N Engl J Med. 2007; 356: 1295-1303
        • Plana M.N.
        • Carreira C.
        • Muriel A.
        • et al.
        Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis.
        Eur Radiol. 2012; 22: 26-38
        • Lewin J.M.
        • Patel B.K.
        • Tann A.
        Contrast-enhanced mammography: a scientific review.
        J Breast Imaging. 2020; 2: 7-15