Abstract P1-02-06: Retrospective comparison of sensitivity and positive predictive value (PPV) of contrast enhanced spectral mammography (CESM) to contrast enhanced breast MRI (BMRI) in 50 malignant breasts
Authors: Li Luna , Liao Lydia , Germaine Pauline , Tinney Elizabeth , Brill Kristin , Hendershott Karen 
Published: May 2015

Abstract
Objective: Contrast enhanced spectral mammography (CESM) is a new study using contrast for early breast cancer detection. It utilizes dual energy digital mammographic technology to detect contrast enhanced cancer that may be invisible on conventional mammogram. Limited studies have shown that adding CESM to diagnostic workup adjunct with mammogram and breast ultrasound does increase sensitivity for breast cancer detection. More studies are needed to compare the sensitivity and positive predictive value (PPV) of CESM to BMRI to further define the role of CESM in breast cancer diagnosis.
Methods: This study involved 50 malignant breasts in 48 women retrospectively chosen from of 960 patients in our institution during the period of October 2012 to March 2014. Both CESM and BMRI were done for each patient within 30 days. The cancer diagnoses were confirmed by tissue diagnoses. The number of malignant lesions was quantified in each breast. The size of lesions was classified into three categories based on standard of breast cancer stages: 1 (0.2cm -&lt;= 2cm), 2 (2cm&lt;lesion&lt;=5cm), 3(&gt;5cm). The enhancement intensity of both lesions and background has been quantified based on a scale of 0-3. Statistical significance was analyzed using T test for mean size of index cancer and mean score of enhancement intensity of background and lesions on CESM and BMRI. Sensitivity and PPV were calculated for both CESM and BMRI. Morphology consistence was calculated on both studies.
Results: Both CESM and BMRI have sensitivity of 100% for breast cancer detection. CESM has a PPV of 98% versus 93% for BMRI. No statistical significance was identified on mean size of index cancer (3.7cm for CESM and 3.8cm for BMRI). The enhancement intensity of background and lesions is significantly higher on CESM than on BMRI (p&lt;0.01). The smallest cancer can be detected by both CESM and BMRI is less than 0.5 cm. Morphology consistence was 46/50 (92%). Of the 50 breasts, there was one false-positive finding at CESM mammography, and four false-positive findings at MR imaging.
Conclusions: Our study indicates that CESM and BMRI have comparable high sensitivity on breast cancer detection. CESM has a higher PPV than BMRI that may indicate a better specificity (no significant difference due to the small sample size). Significantly less background enhancement intensity on CESM than on BMRI reflect an increased specificity. More studies need to be conducted for further evaluation.
Citation Format: Luna Li, Lydia Liao, Pauline Germaine, Elizabeth Tinney, Kristin Brill, Karen Hendershott. Retrospective comparison of sensitivity and positive predictive value (PPV) of contrast enhanced spectral mammography (CESM) to contrast enhanced breast MRI (BMRI) in 50 malignant breasts [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-02-06.