Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?

Eva Maria Fallenberg; Clarisse Dromain; Felix Diekmann; Diane M. Renz; Heba Amer; Barbara Ingold-Heppner; Avidan U. Neumann; Klaus J. Winzer; Ulrich Bick; Bernd Hamm; Florian Engelken

doi:10.1007/s10549-014-3023-6

Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?

Eva Maria Fallenberg, Clarisse Dromain, Felix Diekmann, Diane M. Renz, Heba Amer, Barbara Ingold-Heppner, Avidan U. Neumann, Klaus J. Winzer, Ulrich Bick, Bernd Hamm, Florian Engelken

The Mina and Everard Goodman Faculty of Life Sciences

Research output: Contribution to journal › Article › peer-review

95 Scopus citations

Abstract

The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) with mammography (MG) and combined CESM + MG in terms of detection and size estimation of histologically proven breast cancers in order to assess the potential to reduce radiation exposure. A total of 118 patients underwent MG and CESM and had final histological results. CESM was performed as a bilateral examination starting 2 min after injection of iodinated contrast medium. Three independent blinded radiologists read the CESM, MG, and CESM + MG images with an interval of at least 4 weeks to avoid case memorization. Sensitivity and size measurement correlation and differences were calculated, average glandular dose (AGD) levels were compared, and breast densities were reported. Fisher's exact and Wilcoxon tests were performed. A total of 107 imaging pairs were available for analysis. Densities were ACR1: 2, ACR2: 45, ACR3: 42, and ACR4: 18. Mean AGD was 1.89 mGy for CESM alone, 1.78 mGy for MG, and 3.67 mGy for the combination. In very dense breasts, AGD of CESM was significantly lower than MG. Sensitivity across readers was 77.9 % for MG alone, 94.7 % for CESM, and 95 % for CESM + MG. Average tumor size measurement error compared to postsurgical pathology was -0.6 mm for MG, +0.6 mm for CESM, and +4.5 mm for CESM + MG (p < 0.001 for CESM + MG vs. both modalities). CESM alone has the same sensitivity and better size assessment as CESM + MG and was significantly better than MG with only 6.2 % increase in AGD. The combination of CESM + MG led to systematic size overestimation. When a CESM examination is planned, additional MG can be avoided, with the possibility of saving up to 61 % of radiation dose, especially in patients with dense breasts.

Original language	English
Pages (from-to)	371-381
Number of pages	11
Journal	Breast Cancer Research and Treatment
Volume	146
Issue number	2
DOIs	https://doi.org/10.1007/s10549-014-3023-6
State	Published - Jul 2014

Bibliographical note

Funding Information:
Conflict of interest E.M.F. Financial activities related to the present article: GE Healthcare provided some funding to pay for the actual research per patient, but authors were completely in control of the patients and data. E.M.F. received payment for lecture or advisory board participation from GE, Bayer and Siemens and funding from Siemens, Bayer and GE. B.H. received payment for consultancy for Toshiba and is stock holder of all medical companies. F.D. received payment for lecture or advisory board participation from GE and Phillips and funding from GE, Bayer and Mevis. C.D. received funding from GE. U.B. received remuneration for License agreements and Royalties from Hologic and funding from Siemens, Hologic and Toshiba. D.M.R, A.U.N., K-J.W., B.I., and F.E. had no conflicts of interest.

Funding Information:
This prospective, intra-individual comparison was performed in accordance with the Declaration of Helsinki and was approved by the German Federal Institute for Drugs and Medical Devices, the Federal Office for Radiation Protection, and the local ethics committee. All patients eligible for the study were willing to undergo all study procedures and provided written informed consent prior to enrollment. The study was supported by a research grant from GE Healthcare. The investigators had exclusive control of all data, manuscript drafting, and submission of this study. Parts of the same image dataset used in this study were used in an analysis of a clinical on site single-reader evaluation of CESM in comparison with MG reports and MRI reports [15].

Funding

Conflict of interest E.M.F. Financial activities related to the present article: GE Healthcare provided some funding to pay for the actual research per patient, but authors were completely in control of the patients and data. E.M.F. received payment for lecture or advisory board participation from GE, Bayer and Siemens and funding from Siemens, Bayer and GE. B.H. received payment for consultancy for Toshiba and is stock holder of all medical companies. F.D. received payment for lecture or advisory board participation from GE and Phillips and funding from GE, Bayer and Mevis. C.D. received funding from GE. U.B. received remuneration for License agreements and Royalties from Hologic and funding from Siemens, Hologic and Toshiba. D.M.R, A.U.N., K-J.W., B.I., and F.E. had no conflicts of interest. This prospective, intra-individual comparison was performed in accordance with the Declaration of Helsinki and was approved by the German Federal Institute for Drugs and Medical Devices, the Federal Office for Radiation Protection, and the local ethics committee. All patients eligible for the study were willing to undergo all study procedures and provided written informed consent prior to enrollment. The study was supported by a research grant from GE Healthcare. The investigators had exclusive control of all data, manuscript drafting, and submission of this study. Parts of the same image dataset used in this study were used in an analysis of a clinical on site single-reader evaluation of CESM in comparison with MG reports and MRI reports [15].

Funders	Funder number
Bayer
GE Healthcare
Siemens

Keywords

Breast cancer
Contrast media
Contrast-enhanced spectral mammography
Detection
Digital mammography
Dual-energy
Radiation exposure
Sensitivity

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s10549-014-3023-6

Cite this

Fallenberg, E. M., Dromain, C., Diekmann, F., Renz, D. M., Amer, H., Ingold-Heppner, B., Neumann, A. U., Winzer, K. J., Bick, U., Hamm, B., & Engelken, F. (2014). Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided? Breast Cancer Research and Treatment, 146(2), 371-381. https://doi.org/10.1007/s10549-014-3023-6

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title = "Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?",

abstract = "The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) with mammography (MG) and combined CESM + MG in terms of detection and size estimation of histologically proven breast cancers in order to assess the potential to reduce radiation exposure. A total of 118 patients underwent MG and CESM and had final histological results. CESM was performed as a bilateral examination starting 2 min after injection of iodinated contrast medium. Three independent blinded radiologists read the CESM, MG, and CESM + MG images with an interval of at least 4 weeks to avoid case memorization. Sensitivity and size measurement correlation and differences were calculated, average glandular dose (AGD) levels were compared, and breast densities were reported. Fisher's exact and Wilcoxon tests were performed. A total of 107 imaging pairs were available for analysis. Densities were ACR1: 2, ACR2: 45, ACR3: 42, and ACR4: 18. Mean AGD was 1.89 mGy for CESM alone, 1.78 mGy for MG, and 3.67 mGy for the combination. In very dense breasts, AGD of CESM was significantly lower than MG. Sensitivity across readers was 77.9 % for MG alone, 94.7 % for CESM, and 95 % for CESM + MG. Average tumor size measurement error compared to postsurgical pathology was -0.6 mm for MG, +0.6 mm for CESM, and +4.5 mm for CESM + MG (p < 0.001 for CESM + MG vs. both modalities). CESM alone has the same sensitivity and better size assessment as CESM + MG and was significantly better than MG with only 6.2 % increase in AGD. The combination of CESM + MG led to systematic size overestimation. When a CESM examination is planned, additional MG can be avoided, with the possibility of saving up to 61 % of radiation dose, especially in patients with dense breasts.",

keywords = "Breast cancer, Contrast media, Contrast-enhanced spectral mammography, Detection, Digital mammography, Dual-energy, Radiation exposure, Sensitivity",

author = "Fallenberg, {Eva Maria} and Clarisse Dromain and Felix Diekmann and Renz, {Diane M.} and Heba Amer and Barbara Ingold-Heppner and Neumann, {Avidan U.} and Winzer, {Klaus J.} and Ulrich Bick and Bernd Hamm and Florian Engelken",

note = "Funding Information: Conflict of interest E.M.F. Financial activities related to the present article: GE Healthcare provided some funding to pay for the actual research per patient, but authors were completely in control of the patients and data. E.M.F. received payment for lecture or advisory board participation from GE, Bayer and Siemens and funding from Siemens, Bayer and GE. B.H. received payment for consultancy for Toshiba and is stock holder of all medical companies. F.D. received payment for lecture or advisory board participation from GE and Phillips and funding from GE, Bayer and Mevis. C.D. received funding from GE. U.B. received remuneration for License agreements and Royalties from Hologic and funding from Siemens, Hologic and Toshiba. D.M.R, A.U.N., K-J.W., B.I., and F.E. had no conflicts of interest. Funding Information: This prospective, intra-individual comparison was performed in accordance with the Declaration of Helsinki and was approved by the German Federal Institute for Drugs and Medical Devices, the Federal Office for Radiation Protection, and the local ethics committee. All patients eligible for the study were willing to undergo all study procedures and provided written informed consent prior to enrollment. The study was supported by a research grant from GE Healthcare. The investigators had exclusive control of all data, manuscript drafting, and submission of this study. Parts of the same image dataset used in this study were used in an analysis of a clinical on site single-reader evaluation of CESM in comparison with MG reports and MRI reports [15].",

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month = jul,

doi = "10.1007/s10549-014-3023-6",

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volume = "146",

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Fallenberg, EM, Dromain, C, Diekmann, F, Renz, DM, Amer, H, Ingold-Heppner, B, Neumann, AU, Winzer, KJ, Bick, U, Hamm, B & Engelken, F 2014, 'Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?', Breast Cancer Research and Treatment, vol. 146, no. 2, pp. 371-381. https://doi.org/10.1007/s10549-014-3023-6

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T1 - Contrast-enhanced spectral mammography

T2 - Does mammography provide additional clinical benefits or can some radiation exposure be avoided?

AU - Fallenberg, Eva Maria

AU - Dromain, Clarisse

AU - Diekmann, Felix

AU - Renz, Diane M.

AU - Amer, Heba

AU - Ingold-Heppner, Barbara

AU - Neumann, Avidan U.

AU - Winzer, Klaus J.

AU - Bick, Ulrich

AU - Hamm, Bernd

AU - Engelken, Florian

N1 - Funding Information: Conflict of interest E.M.F. Financial activities related to the present article: GE Healthcare provided some funding to pay for the actual research per patient, but authors were completely in control of the patients and data. E.M.F. received payment for lecture or advisory board participation from GE, Bayer and Siemens and funding from Siemens, Bayer and GE. B.H. received payment for consultancy for Toshiba and is stock holder of all medical companies. F.D. received payment for lecture or advisory board participation from GE and Phillips and funding from GE, Bayer and Mevis. C.D. received funding from GE. U.B. received remuneration for License agreements and Royalties from Hologic and funding from Siemens, Hologic and Toshiba. D.M.R, A.U.N., K-J.W., B.I., and F.E. had no conflicts of interest. Funding Information: This prospective, intra-individual comparison was performed in accordance with the Declaration of Helsinki and was approved by the German Federal Institute for Drugs and Medical Devices, the Federal Office for Radiation Protection, and the local ethics committee. All patients eligible for the study were willing to undergo all study procedures and provided written informed consent prior to enrollment. The study was supported by a research grant from GE Healthcare. The investigators had exclusive control of all data, manuscript drafting, and submission of this study. Parts of the same image dataset used in this study were used in an analysis of a clinical on site single-reader evaluation of CESM in comparison with MG reports and MRI reports [15].

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N2 - The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) with mammography (MG) and combined CESM + MG in terms of detection and size estimation of histologically proven breast cancers in order to assess the potential to reduce radiation exposure. A total of 118 patients underwent MG and CESM and had final histological results. CESM was performed as a bilateral examination starting 2 min after injection of iodinated contrast medium. Three independent blinded radiologists read the CESM, MG, and CESM + MG images with an interval of at least 4 weeks to avoid case memorization. Sensitivity and size measurement correlation and differences were calculated, average glandular dose (AGD) levels were compared, and breast densities were reported. Fisher's exact and Wilcoxon tests were performed. A total of 107 imaging pairs were available for analysis. Densities were ACR1: 2, ACR2: 45, ACR3: 42, and ACR4: 18. Mean AGD was 1.89 mGy for CESM alone, 1.78 mGy for MG, and 3.67 mGy for the combination. In very dense breasts, AGD of CESM was significantly lower than MG. Sensitivity across readers was 77.9 % for MG alone, 94.7 % for CESM, and 95 % for CESM + MG. Average tumor size measurement error compared to postsurgical pathology was -0.6 mm for MG, +0.6 mm for CESM, and +4.5 mm for CESM + MG (p < 0.001 for CESM + MG vs. both modalities). CESM alone has the same sensitivity and better size assessment as CESM + MG and was significantly better than MG with only 6.2 % increase in AGD. The combination of CESM + MG led to systematic size overestimation. When a CESM examination is planned, additional MG can be avoided, with the possibility of saving up to 61 % of radiation dose, especially in patients with dense breasts.

AB - The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) with mammography (MG) and combined CESM + MG in terms of detection and size estimation of histologically proven breast cancers in order to assess the potential to reduce radiation exposure. A total of 118 patients underwent MG and CESM and had final histological results. CESM was performed as a bilateral examination starting 2 min after injection of iodinated contrast medium. Three independent blinded radiologists read the CESM, MG, and CESM + MG images with an interval of at least 4 weeks to avoid case memorization. Sensitivity and size measurement correlation and differences were calculated, average glandular dose (AGD) levels were compared, and breast densities were reported. Fisher's exact and Wilcoxon tests were performed. A total of 107 imaging pairs were available for analysis. Densities were ACR1: 2, ACR2: 45, ACR3: 42, and ACR4: 18. Mean AGD was 1.89 mGy for CESM alone, 1.78 mGy for MG, and 3.67 mGy for the combination. In very dense breasts, AGD of CESM was significantly lower than MG. Sensitivity across readers was 77.9 % for MG alone, 94.7 % for CESM, and 95 % for CESM + MG. Average tumor size measurement error compared to postsurgical pathology was -0.6 mm for MG, +0.6 mm for CESM, and +4.5 mm for CESM + MG (p < 0.001 for CESM + MG vs. both modalities). CESM alone has the same sensitivity and better size assessment as CESM + MG and was significantly better than MG with only 6.2 % increase in AGD. The combination of CESM + MG led to systematic size overestimation. When a CESM examination is planned, additional MG can be avoided, with the possibility of saving up to 61 % of radiation dose, especially in patients with dense breasts.

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Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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