Anne-Marie Tardivel, Presenter: Nothing to Disclose

Corinne Balleyguier MD, Abstract Co-Author: Nothing to Disclose

Sandra Canale, Abstract Co-Author: Nothing to Disclose

Suzette Delaloge MD, Abstract Co-Author: Nothing to Disclose

chafika mazouni, Abstract Co-Author: Nothing to Disclose

Marie Christine Mathieu, Abstract Co-Author: Nothing to Disclose

Clarisse Dromain MD, Abstract Co-Author: Nothing to Disclose

To assess the added value on medical and surgical strategy of contrast-enhanced spectral mammography (CESM) in comparison to mammography (MG) and ultrasound (US) in breast cancer in a One Stop Breast unit.

Between September 2012 and September 2013, 195 women with a suspicious or undetermined breast lesion on MG and US underwent bilateral CESM in a one shot-stop breast unit. BI-RADS categories and probability of malignancy, retrospectively and blindly estimated by two radiologists, were compared to pathology or follow-up for typically benign lesions. Diagnostic performances were estimated. Size measurement of index lesions on CESM, US and MG were compared to pathology. Changes of medical and surgical strategy were recorded.

299 lesions were detected including 221 malignant lesions (172 infiltrative ductal carcinoma, 28 lobular infiltrative carcinoma, 13 ductal carcinoma in situ, 4 infiltrative mixed carcinoma, 3 tubular carcinoma, 1 mucinous carcinoma) in 157 / 195 patients (81%). CESM sensitivity, specificity, positive predictive value and negative predictive value were 94% (IC 89%-6%), 74% (IC 63%-83%), 91% (IC 86%-94%) and 81% (IC 70%-89%), respectively, with 18 false-positive and 14 false-negative findings. In 115 index lesions, MG and CESM were more accurate than US compared to pathology (p<0,001). No evidence of a difference in size estimation between MG and CESM was found compared to pathology (p=0,64) but dispersion values were lower for CESM. CESM changed diagnostic and treatment strategy in 41 (21%) patients, with a more extensive surgery (n=21) and neoadjuvant chemotherapy (n=1). A biopsy was avoided in 20 patients with negative CESM, as a benign lesion was confirmed by follow-up (mean of a year). Diagnostic and treatment changes according to CESM were independent from breast density, tumour type and mammographic/sonographic findings.

Routine use of CESM confirms its good clinical performances. CESM may be performed easily in a One Stop Breast unit and may change significantly the diagnostic and treatment strategy in breast cancer staging.

CESM is a valuable imaging technique allowing to reduce mammogram uncertainty in a post screening one shot-stop breast unit.

Tardivel, A, Balleyguier, C, Canale, S, Delaloge, S, mazouni, c, Mathieu, M, Dromain, C, Added Value of Contrast-enhanced Spectral Mammography as Part of One Stop Breast Unit.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014587.html