This study aimed to compare the diagnostic performance of pre-operative evaluation of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) and to evaluate the effect of each modality to the surgical management in women with breast cancer.
This single-institution prospective study was approved by the Institutional Review Board and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients, who were diagnosed as invasive carcinoma (69/84) and ductal carcinoma in situ (DCIS) (15/84) underwent both CEDM and CEMRI, were enrolled. We correlated the imaging findings and surgical management with pathologic results, and compared the diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in contralateral breast. We also evaluated whether CEDM or CEMRI made changes in surgical management of the affected breast attributed to imaging-detected findings.
Eighty-four women were included for analysis. CEDM, in comparison to CEMRI, had a significantly higher specificity (66.7% vs 22.2%, P = 0.021), similar sensitivity (94.6% [78/84] vs 93.5% [81/84]), PPV (93.5% vs 86.0%) and a fewer false positive findings (66.7% [10/15] vs 93.3% [14/15]) in detecting index cancer. For detection of secondary cancers on ipsilateral breast and occult cancer in contralateral breast, no significant differences were found between CEDM and CEMRI (all P > 0.05). Regarding changes in surgical management, CEDM made less change (36.9% [31/84] vs 41.7% [35/84]) than CEMRI, owing to less false positive findings (48.4% [15/31] vs 54.3% [19/35]).
CEDM showed comparable diagnostic performance with CEMRI in depicting index, secondary cancers, and occult cancer in contralateral breast. The CEDM, owing to fewer false positive results, made less change in surgical management compared to CEMRI.
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All authors have declared no conflicts of interest.