Radiologists can be thoughtful about whether to image the axilla, discussing risks and benefits with surgical colleagues, because it is not universally recommended [37]. Mammography With IV Contrast Several retrospective studies have compared the sensitivity and specificity of CEM with conventional 2-D and 3-D mammography, US, and MRI. Overall, CEM and MRI are superior to DM and DM/DBT imaging [47]. The sensitivities between CEM and MRI are comparable, with some studies showing improved sensitivities with CEM [48] and some showing MRI to be superior [49,50]. Overall sensitivities ranged from 92% to 100% [16,49,51-53], including CEM detecting 92.3% of satellite masses and up to 100% of contralateral cancers [28]. CEM and MRI show similar abilities to estimate tumor size (r = 0.72-0.89 versus 0.65-0.84), but studies have shown an improved positive predictive value (PPV) of CEM (52%-93%) compared with MRI (28-60%) [16,49,53]. Despite increased specificity over MR, limitations of contrast mammography in determining disease extent include evaluation of the axilla and other nodal groups as well as chest wall involvement [47], and there is evidence against using CEM to determine disease extent in lobular cancer, due to lower conspicuity [54]. MRI Breast Without and With IV Contrast MRI breast is useful for detecting additional cancers in the ipsilateral or contralateral breast [16,55], particularly in women with dense breasts [23,56,57]. A meta-analysis of 22 studies investigated MRI screening of the contralateral breast in women with newly diagnosed breast cancer. This meta-analysis reported contralateral malignancies that were detected by MRI in 131 of 3,253 women. Thus, the summary estimate for incremental cancer detection rate was 4.1%. In studies in which pathologic tumor stage was reported, all but 2 tumors were in situ or stage I, and of those 2 tumors, 1 was node-negative ILC (42 mm). Summary estimates were as follows: MRI-directed additional
Imaging of Invasive Breast Cancer. Radiologists can be thoughtful about whether to image the axilla, discussing risks and benefits with surgical colleagues, because it is not universally recommended [37]. Mammography With IV Contrast Several retrospective studies have compared the sensitivity and specificity of CEM with conventional 2-D and 3-D mammography, US, and MRI. Overall, CEM and MRI are superior to DM and DM/DBT imaging [47]. The sensitivities between CEM and MRI are comparable, with some studies showing improved sensitivities with CEM [48] and some showing MRI to be superior [49,50]. Overall sensitivities ranged from 92% to 100% [16,49,51-53], including CEM detecting 92.3% of satellite masses and up to 100% of contralateral cancers [28]. CEM and MRI show similar abilities to estimate tumor size (r = 0.72-0.89 versus 0.65-0.84), but studies have shown an improved positive predictive value (PPV) of CEM (52%-93%) compared with MRI (28-60%) [16,49,53]. Despite increased specificity over MR, limitations of contrast mammography in determining disease extent include evaluation of the axilla and other nodal groups as well as chest wall involvement [47], and there is evidence against using CEM to determine disease extent in lobular cancer, due to lower conspicuity [54]. MRI Breast Without and With IV Contrast MRI breast is useful for detecting additional cancers in the ipsilateral or contralateral breast [16,55], particularly in women with dense breasts [23,56,57]. A meta-analysis of 22 studies investigated MRI screening of the contralateral breast in women with newly diagnosed breast cancer. This meta-analysis reported contralateral malignancies that were detected by MRI in 131 of 3,253 women. Thus, the summary estimate for incremental cancer detection rate was 4.1%. In studies in which pathologic tumor stage was reported, all but 2 tumors were in situ or stage I, and of those 2 tumors, 1 was node-negative ILC (42 mm). Summary estimates were as follows: MRI-directed additional