Lewin John M, Patel Bhavika K, Tanna Aneri
The Women's Imaging Center, Denver, CO.
Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ.
J Breast Imaging. 2020 Feb 4;2(1):7-15. doi: 10.1093/jbi/wbz074.
In this paper we provide an overview of contrast-enhanced mammography (CEM) and a review of the published literature in order to provide a picture of the current state of the evidence on the performance of CEM. Clinical research was fairly sparse following the demonstration of the technique in research subjects about 18 years ago, but the number of publications rapidly increased following commercialization 9 years ago, and even more so in the last 5 years. Initial studies compared CEM with mammography, and clearly showed that CEM could detect cancers not visible on mammography. More recent studies have primarily focused on comparing the performance of CEM with contrast-enhanced magnetic resonance imaging (MRI) in selected cohorts. These studies have almost uniformly shown CEM and MRI to have similar sensitivities, with sensitivity and accuracy showing more variability from study to study. With increasing clinical use, a large number of retrospective reviews of CEM have appeared, showing utility of CEM in the diagnostic clinical setting. Most recently, a small number of papers have been published looking at CEM for high-risk and dense breast screening, two potentially large applications of the technique, showing it to outperform mammography in both populations. CEM has clearly been shown to have clinical utility, but more prospective studies, including screening studies, are needed to further evaluate its performance, especially in comparison with MRI.
在本文中，我们概述了对比增强乳腺X线摄影（CEM）并回顾了已发表的文献，以便呈现CEM性能的当前证据状况。大约18年前该技术在研究对象中得到展示后，临床研究相当稀少，但在9年前商业化之后，出版物数量迅速增加，在过去5年中更是如此。最初的研究将CEM与乳腺X线摄影进行了比较，并清楚地表明CEM能够检测出乳腺X线摄影中不可见的癌症。最近的研究主要集中在比较CEM与对比增强磁共振成像（MRI）在特定队列中的性能。这些研究几乎一致表明CEM和MRI具有相似的敏感性，不同研究之间敏感性和准确性的变异性更大。随着临床应用的增加，出现了大量关于CEM的回顾性综述，显示了CEM在诊断临床环境中的实用性。最近，有少数论文发表，探讨了CEM用于高危和致密乳腺筛查这两种该技术潜在的大量应用情况，结果显示在这两类人群中CEM均优于乳腺X线摄影。CEM已明确显示具有临床实用性，但需要更多的前瞻性研究，包括筛查研究，以进一步评估其性能，特别是与MRI进行比较。
