Cortesi et al [35] evaluated the efficacy of biennial screening US examination in women who were BRCA mutation carriers, high-risk (non-BRCA1/2), and intermediate-risk patients. Overall, MRI had sensitivity of 93.7%, followed by mammography with sensitivity of 55.0% and US with 29.4% sensitivity. In the nondense breast, the sensitivity of mammography was 82.5% versus 10% for US. In the dense breast, the sensitivity of mammography was 50% versus 42.6% for US. Sensitivity analysis by risk level was also performed. The US sensitivities for BRCA1/2, high-risk (non-BRCA1/2), and intermediate-risk patients were 22.7%, 24.5%, and 33.6%, respectively. The mammographic sensitivities for BRCA1/2, high-risk (non-BRCA1/2), and intermediate-risk patients were 25.0%, 66.4%, and 56.6%, respectively. Only the BRCA1/2 mutation carriers underwent MRI screening, which demonstrated a sensitivity of 93.7%. The authors did not analyze the efficacy of US screening based on both density and risk. Mammography With IV Contrast CEDM combines the techniques of conventional mammography with administration of IV contrast, thus leveraging functional imaging by assessing for lesion vascularity. A dual-energy technique is used to acquire the images in the conventional craniocaudal and mediolateral oblique projections. The acquired data are processed, producing a low- energy image and a diagnostic recombined image. There is limited but emerging literature regarding the use of CEDM in the screening setting. However, in the diagnostic setting, CEDM has been shown to demonstrate improved sensitivity and specificity over 2-D mammography [28-31]. The greatest improvement in the sensitivity and specificity is seen in women with dense breast tissue [29,30]. However, at this time, there is no relevant literature regarding the use of mammography with IV contrast for supplemental screening in intermediate-risk women with nondense breasts.
Supplemental Breast Cancer Screening Based on Breast Density. Cortesi et al [35] evaluated the efficacy of biennial screening US examination in women who were BRCA mutation carriers, high-risk (non-BRCA1/2), and intermediate-risk patients. Overall, MRI had sensitivity of 93.7%, followed by mammography with sensitivity of 55.0% and US with 29.4% sensitivity. In the nondense breast, the sensitivity of mammography was 82.5% versus 10% for US. In the dense breast, the sensitivity of mammography was 50% versus 42.6% for US. Sensitivity analysis by risk level was also performed. The US sensitivities for BRCA1/2, high-risk (non-BRCA1/2), and intermediate-risk patients were 22.7%, 24.5%, and 33.6%, respectively. The mammographic sensitivities for BRCA1/2, high-risk (non-BRCA1/2), and intermediate-risk patients were 25.0%, 66.4%, and 56.6%, respectively. Only the BRCA1/2 mutation carriers underwent MRI screening, which demonstrated a sensitivity of 93.7%. The authors did not analyze the efficacy of US screening based on both density and risk. Mammography With IV Contrast CEDM combines the techniques of conventional mammography with administration of IV contrast, thus leveraging functional imaging by assessing for lesion vascularity. A dual-energy technique is used to acquire the images in the conventional craniocaudal and mediolateral oblique projections. The acquired data are processed, producing a low- energy image and a diagnostic recombined image. There is limited but emerging literature regarding the use of CEDM in the screening setting. However, in the diagnostic setting, CEDM has been shown to demonstrate improved sensitivity and specificity over 2-D mammography [28-31]. The greatest improvement in the sensitivity and specificity is seen in women with dense breast tissue [29,30]. However, at this time, there is no relevant literature regarding the use of mammography with IV contrast for supplemental screening in intermediate-risk women with nondense breasts.