Diagnostic Accuracy of Contrast Enhanced Spectral Mammography in Assessment of Indeterminate Breast Lesions in Patients after Breast Conservation Surgery

Abstract Background: Breast cancer in women represents a major public health problem being the most common cancer among women in both developed and developing countries, it accounts for 22.9% of all new female cancers. In Egypt breast cancer accounts for 37.7% of the total new cancer cases. Contrast Enhanced Spectral Mammography (CESM) is an emerging advanced technique that depict breast tumor angiogenesis. CESM as an adjunct to Mammography (MG) with or without Ultrasound (US) has higher diagnostic accuracy compared to MG with or without US.
Aim of Work: To evaluate the diagnostic accuracy of contrast enhanced spectral digital mammography versus the digital mammography in assessment of indeterminate breast lesions in patients after breast conservation surgery.
Patients and Methods: 20 female patients under follow-up after breast conservative surgery presenting with indeter-minate/suspicious breast lesion on mammography had been evaluated by dual-energy contrast enhanced spectral mam-mography. The age ranged from 40 to 65 years (mean=50.3). Results of histo-pathological examinations of surgical or biopsy specimens were obtained and served as the gold standard. Results: The surgical and pathological results of our patients revealed 6/20 (30.0%) benign lesions and 14/20 (70.0%) malignant lesions. CESM had a sensitivity of 85.7%, a specificity of 71.4%, a positive predictive value of 92.3%, a negative predictive value of 71.4% compared to digital mammography results which were 71.4%, 71.4%, 90.9% and 55.6% respectively.
Conclusion: CESM is a promising tool for increasing the sensitivity and the diagnostic accuracy of conventional mam-mography in follow-up of patients with breast conservative surgery.