Contrast-enhanced mammography combined (CEM) combined with ultrasound (US) as a single preoperative staging evaluation is found to be as effective as magnetic resonance imaging (MRI) in a study published August 2, 2021, in the European Journal of Radiology.

CEM and MRI Have Equal Performance

“For locoregional staging, assessment of intramammary tumor extent and presence of axillary and perhaps also internal mammary lymph node metastases is required. Due to the similarity in the underlying principle, contrast-enhanced mammography is increasingly considered instead of breast MRI for this purpose. When considering the combination of CEM and US as a single appointment imaging strategy for preoperative staging of breast cancer, there is only limited room for an additional benefit of breast MRI. For tumor size measurements, equal performance of both CEM and MRI are observed,” writes Dr. M.B.I. Lobbes, lead author, and his team.

Highlights

• “CEM is able to assess breast cancer extent as accurately as MRI.
• For assessing axillary nodes, US has equal diagnostic performance as breast MRI.
• ‘Missing’ internal mammary lymph node metastases has limited consequences.
• MRI remains the preferred imaging modality for a select group of women.
• In all other sub groups, CEM can be considered for preoperative staging.”

Preoperative staging, required in women newly diagnosed with breast cancer, is conducted to determine the size and extent of the tumor and any metastases present. While MRI is often used for this, the study authors note that MRI can overestimate the extent of tumors by nearly two millimeters, while CEM did not; other studies cited by the team showed comparable performance between the two methods. The team noted that women who have breast implants, lobular cancer, allergic reactions to iodinated contrast agents, renal insufficiency, or when breast lesions aren’t present within the mammographic field of view are better candidates for MRI. For those women not in this group, CEM combined with US makes MRI unnecessary for preoperative staging.

Sources:

M.B.I. Lobbes, E.M. Heuts, M. Moossdorff, T.J.A. van Nijnatten, “Contrast enhanced mammography (CEM) versus magnetic resonance imaging (MRI) for staging of breast cancer: The pro CEM perspective” European Journal of Radiology Available: August 2, 2021, at https://www.ejradiology.com/article/S0720-048X(21)00364-8/fulltext Accessed August 16, 2021

Amerigo Allegretto, “Contrast mammography plus ultrasound on par with MRI for preop staging” Available August 5, 2021 at https://www.auntminnie.com/index.aspx?Sec=sup&Sub=xra&Pag=dis&ItemId=133141  Accessed August 16, 2021

Hashem, L.M.B., Abd El Hamid, N.O., Kamal, R.M. et al. Does contrast-enhanced mammography have an impact on the detection of cancer in patients with risk of developing breast cancer?. Egypt J Radiol Nucl Med 52, 71 (2021). https://doi.org/10.1186/s43055-021-00447-8 Accessed: August 16, 2021.