Does Contrast-Enhanced Mammography Outperform Digital Breast Tomosynthesis for Detection and Characterization of Breast Lesions or Vice Versa?

Mammograms are the mainstay of diagnostic breast imaging and cancer screening. Despite mammography advances like full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT), these imaging techniques provide purely structural information. Though the most sensitive modality for breast cancer detection is magnetic resonance imaging (MRI), its widespread use has been limited due to high cost, long scan times, and lack of availability. Contrast-enhanced mammography (CEM) is a novel technique which combines dual energy FFDM with injection of iodinated contrast. It provides structural and functional imaging similar to MRI. The objectives of this study were to assess and compare the diagnostic performance of CEM and DBT in characterizing breast lesions and to analyze additional findings revealed by CEM and examining their implications for patient management. This was a single center prospective observational study on 58 women with BI-RADS category of 3, 4, and 5 breast lesions who underwent CEM following DBT. CEM detected 62 lesions, out of which 46 were categorized as suspicious/malignant and 16 as benign. On histopathology, 44 turned out to be malignant and 18 benign. CEM achieved a sensitivity of 100% and specificity of 88%. In contrast, DBT identified 56 of these 62 lesions (42 were malignant and 14 were benign on histopathology), with sensitivity of 95% and specificity of 77.8%. Compared to DBT, CEM provided superior delineation of disease extent, depicting multifocal and multicentric lesions, as well as picking up lesions in contralateral breasts, thereby altering patient management.