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 Imaging of Invasive Breast Cancer [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 improved 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 and 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. The study 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 a node-negative ILC (42 mm). Summary estimates were as follows: MRI-directed additional biopsy in 9.3% of women (95% CI, 5.8%-14.7%) with PPV for malignancy of 47.9% (95% CI, 31.8%- 64.6%).
Imaging of Invasive Breast Cancer. 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 Imaging of Invasive Breast Cancer [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 improved 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 and 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. The study 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 a node-negative ILC (42 mm). Summary estimates were as follows: MRI-directed additional biopsy in 9.3% of women (95% CI, 5.8%-14.7%) with PPV for malignancy of 47.9% (95% CI, 31.8%- 64.6%).