The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia.
Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, Australia.
Breast Cancer Res Treat. 2023 Jun;199(2):221-230. doi: 10.1007/s10549-023-06916-0. Epub 2023 Mar 25.
Mammography (MG) is the standard imaging in surveillance of women with a personal history of breast cancer or DCIS (PHBC), supplemented with ultrasound. Contrast Enhanced Mammography (CEM) has higher sensitivity than MG and US. We report the performance of CEM compared with MG ± US.
A retrospective study of patients undergoing their first surveillance CEM in an Australian hospital setting between June 2006 and October 2020. Cases where a patient was recalled for assessment were identified, recording radiology, pathology and treatment details. Blinded re-reading of recalled cases was performed to determine the contribution of contrast. Use of surveillance US across the board was assessed for the period.
73/1191 (6.1%) patients were recalled. 35 (48%) were true positives (TP), with 26 invasive cancers and 9 cases of DCIS, while 38 (52%) were false positive (FP) with a positive predictive value (PPV) 47.9%. 32/73 were recalled due to MG findings, while 41/73 were only recalled due to Contrast. 14/73 had 'minimal signs' with a lesion identifiable on MG with knowledge of the contrast finding, while 27/73 were visible only with contrast. 41% (17/41) recalled due to contrast were TP. Contrast-only TPs were found with low and high mammographic density (MD). Screening breast US reduced by 55% in the year after CEM was implemented.
Compared to MG, CEM as a single surveillance modality for those with PHBC has higher sensitivity and comparable specificity, identifying additional malignant lesions that are clinically significant. Investigation of interval cancer and subsequent round outcomes is warranted.
乳腺 X 线摄影术（MG）是具有乳腺癌个人史或 DCIS（PHBC）的女性监测的标准影像学方法，辅以超声检查。对比增强乳腺摄影术（CEM）比 MG 和 US 具有更高的敏感性。我们报告了 CEM 与 MG±US 的性能比较。
回顾性研究了 2006 年 6 月至 2020 年 10 月期间在澳大利亚医院接受首次监测 CEM 的患者。确定了召回评估的患者病例，记录了放射学、病理学和治疗细节。对召回病例进行了盲法重读，以确定对比的贡献。评估了整个监测期间使用超声检查的情况。
1191 例患者中有 73 例（6.1%）被召回。35 例（48%）为真阳性（TP），其中 26 例为浸润性癌，9 例为 DCIS，而 38 例（52%）为假阳性（FP），阳性预测值（PPV）为 47.9%。73 例中有 32 例因 MG 发现而被召回，而 41 例仅因对比而被召回。73 例中有 14 例（14/73）“有轻微迹象”，MG 上可识别病变，而对比检查发现有 27 例（27/73）仅通过对比检查发现。41%（17/41）因对比而召回的是 TP。在 CEM 实施后的一年中，筛查性乳腺超声检查减少了 55%。
与 MG 相比，对于 PHBC 患者，CEM 作为单一监测方法具有更高的敏感性和相当的特异性，可识别出更多具有临床意义的恶性病变。需要对间期癌和后续轮次的结果进行研究。
