Adding the merits of contrast to the ease of mammography; can we highlight what’s behind breast asymmetries?

Abstract

Background: Breast symmetry is one of the major things that radiologists assess when looking at mammograms and is one of the most challenging mammographic findings to evaluate. Contrast-enhanced spectral mammography (CESM) is an emerging mammography technique that has shown comparable sensitivity and specificity to MRI. The purpose of this study is to assess the value of CESM in characterization of breast asymmetries (BAs) and if it should be incorporated in its diagnostic work-up. Results: Three hundred sixty-five patients with mean age of 47 years were included in the study. CESM was performed aiming for characterization of 380 suspicious or indeterminate breast asymmetries. Assessment of subtracted high-energy images (HEI) markedly improves the overall accuracy reaching 88.4%. Further improvement of the overall accuracy was achieved on combined assessment of the low-energy images (LEI), subtracted high-energy images (HEI), and ultrasound reaching 91.3%. Conclusion: CESM is considered as a valuable complementary imaging tool considering the evaluation of breast asymmetries and should be incorporated in its diagnostic work-up in cases not resolved on an initial combined mammography and targeted ultrasound study especially in the presence of a heterogeneous dense breast parenchyma. Yet, this may be hindered in the presence of inflammatory signs because of the overlapping imaging criteria.