Contrast-enhanced spectral mammography vs. mammography and MRI - clinical performance in a multi-reader evaluation.

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Bibliographic Details
Title:	Contrast-enhanced spectral mammography vs. mammography and MRI - clinical performance in a multi-reader evaluation.
Authors:	Fallenberg, Eva¹ eva.fallenberg@charite.de, Schmitzberger, Florian¹, Amer, Heba¹, Ingold-Heppner, Barbara², Balleyguier, Corinne³, Diekmann, Felix⁴, Engelken, Florian¹, Mann, Ritse⁵, Renz, Diane⁶, Bick, Ulrich¹, Hamm, Bernd¹, Dromain, Clarisse³, Fallenberg, Eva M⁷ (AUTHOR), Schmitzberger, Florian F⁷ (AUTHOR), Mann, Ritse M⁸ (AUTHOR), Renz, Diane M⁹ (AUTHOR)
Source:	European Radiology. Jul2017, Vol. 27 Issue 7, p2752-2764. 13p. 2 Black and White Photographs, 2 Diagrams, 5 Charts, 2 Graphs.
Subjects:	Breast cancer diagnosis, Contrast-enhanced magnetic resonance imaging, Breast cancer treatment, Mammograms, Pearson correlation (Statistics), Receiver operating characteristic curves, Breast tumors, Comparative studies, Longitudinal method, Magnetic resonance imaging, Research methodology, Medical cooperation, Research, Evaluation research, Contrast media, Drug administration, Drug dosage
Abstract:	Objectives: To compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) to digital mammography (MG) and magnetic resonance imaging (MRI) in a prospective two-centre, multi-reader study.Methods: One hundred seventy-eight women (mean age 53 years) with invasive breast cancer and/or DCIS were included after ethics board approval. MG, CESM and CESM + MG were evaluated by three blinded radiologists based on amended ACR BI-RADS criteria. MRI was assessed by another group of three readers. Receiver-operating characteristic (ROC) curves were compared. Size measurements for the 70 lesions detected by all readers in each modality were correlated with pathology.Results: Reading results for 604 lesions were available (273 malignant, 4 high-risk, 327 benign). The area under the ROC curve was significantly larger for CESM alone (0.84) and CESM + MG (0.83) compared to MG (0.76) (largest advantage in dense breasts) while it was not significantly different from MRI (0.85). Pearson correlation coefficients for size comparison were 0.61 for MG, 0.69 for CESM, 0.70 for CESM + MG and 0.79 for MRI.Conclusions: This study showed that CESM, alone and in combination with MG, is as accurate as MRI but is superior to MG for lesion detection. Patients with dense breasts benefitted most from CESM with the smallest additional dose compared to MG.Key Points: • CESM has comparable diagnostic performance (ROC-AUC) to MRI for breast cancer diagnostics. • CESM in combination with MG does not improve diagnostic performance. • CESM has lower sensitivity but higher specificity than MRI. • Sensitivity differences are more pronounced in dense and not significant in non-dense breasts. • CESM and MRI are significantly superior to MG, particularly in dense breasts. [ABSTRACT FROM AUTHOR]
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Database:	Engineering Source

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