TITLE:
Contrast-Enhanced Mammogram: A New Game-Changer in Breast Imaging. Indications with Case-Based Experience
AUTHORS:
Chotai Niketa, Loke Siu Cheng, Tan Ern Yu
KEYWORDS:
Contrast-Enhanced Mammography, Clinical Use, Advantages, Indications
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.10 No.4,
October
8,
2021
ABSTRACT: Mammograms
are the mainstay of diagnostic breast imaging and cancer screening. Despite advances in technology such as Full Field Digital
Mammography (FFDM) and Digital Breast Tomosynthesis (DBT), these imaging
techniques are purely structural, and are unable to overcome shortcomings in
mammography posed by dense breast
parenchyma. Magnetic Resonance Imaging (MRI) is the most sensitive modality in breast imaging, due to its functional aspects in
addition to structural imaging with this modality. The use of MRI is however
constrained by cost and availability. The utilization of intravenous contrast with mammograms introduces a
functional element to imaging. This greatly
improves the sensitivity of the examination, approaching sensitivity
levels of Magnetic Resonance Imaging (MRI) in the detection of primary breast
cancer. With increased sensitivity afforded
by assessment of tumor neo-vascularity, as well as its low
cost, low energy imaging that is
more readily available than MRI, Contrast-Enhanced
Mammography (CEM) if more readily available than MRI, this imaging modality is
a potential game-changer in breast imaging. In this article, we share our experience in
the use of CEM, for indications previously reserved for MRI, with the literature review of these indications. In resonance with prior studies,
we echo the ease of performing and reporting of CEM as well as greater patient
comfort as the distinct advantages of CEM. In spite of slightly higher
radiation dose and some risks related to contrast media, functional
results at a significantly lower cost may change how we practice breast imaging in the future using CEM.