Katrin S. Blum MD, Presenter: Nothing to Disclose

Christian Rubbert MD, Abstract Co-Author: Fellowship funded, Koninklijke Philips NV

Britta Mathys MD, Abstract Co-Author: Nothing to Disclose

Gerald Antoch MD, Abstract Co-Author: Speaker, Siemens Medical AG Speaker, Bayer AG Speaker, BTG International Ltd

Svjetlana Mohrmann MD, Abstract Co-Author: Nothing to Disclose

Silvia Obenauer MD, Abstract Co-Author: Nothing to Disclose

To prospectively evaluate and compare the accuracy of CESM and ultrasound in size measurement of breast cancer with histologic tumor sizes as gold standard. Artifacts impeding tumor size measurements in CESM were assessed in addition.

21 women aged between 40-73 years (mean age 56 y+/-9y) with histologically proven ductal carcinoma in situ (DCIS) alone, invasive ductal/lobular carcinomas with or without additional DCIS were included in the study. Breast density of patients was classified by the standardized classification system of the American College of Radiology (ACR)`s Breast Imaging Reporting and Data System ACR1-4. Largest tumor diameter in each method was taken as tumor size in each patient. Agreement of imaging tumor size and histopathologic tumor size was evaluated with Bland-Altman analysis.

Motion artifacts did not occur in the study. CESM specific artifacts caused by scattered radiation did not cause any problems in tumor size measurement. In four patients additional enhancement caused most likely by hormone proliferation of breast tissue was seen. Ultrasound in general underestimated tumor size while CESM tumor size measurements lead to a slightly overestimation of tumor size. Mean differences of tumor sizes measurement with CESM was 0.14mm (5.33%) compared to -3.05mm (-11.99%) with ultrasound. Limits of agreement ranged from -18.6 to 18.9mm for CESM, and -19.5 to 13mm in CESM. Especially tumors with size smaller than 23mm were measured more precise with CESM, than tumors with larger size. Ultrasound underestimated tumor size in women with ACR4 breast tissue density.

Similar to MRI CESM leads to a small overestimation of tumor size whereas ultrasound tends to underestimate tumor size. Motion artifacts do not affect CESM images due to strong compression and fixation of the breast. Hormone proliferation causes enhancement of healthy breast and scattered radiation artifact is a special artifact of CESM, which did not affect tumor size measurement in this study.

Breast cancer tumor size and distribution in the breast is important to plan the most adequate therapy. Initial results with CESM show that tumor size measurement with CESM is superior to tumor size measurements with breast ultrasound.

Blum, K, Rubbert, C, Mathys, B, Antoch, G, Mohrmann, S, Obenauer, S, Preoperative Breast Cancer Staging with Contrast Enhanced Spectral Mammography (CESM) in Comparison to Breast Ultrasound: Preliminary Results.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009395.html