AAPM 2021 Breast Imaging 2: Possible Future Directions

CEM is a new imaging modality that harnesses the power of enhancement for cancer detection and combines it with standard mammographic imaging. It is increasingly being used as a diagnostic tool in the clinical setting to evaluate screen-detected abnormalities, to determine extent of disease for newly diagnosed breast cancer patients, to measure neoadjuvant treatment response, and to serve as an alternative to breast MRI. CEM’s markedly improved cancer detection rate compared to standard mammography has led to a growing interest in using CEM for breast cancer screening, particularly in women with dense breast tissue. A large multicenter prospective clinical trial called CMIST is currently being developed to study outcomes of CEM compared with tomosynthesis in a screening population. In addition, contrast-enhanced tomosynthesis (CET) is being developed that employs a post-contrast dualenergy technique during the tomosynthesis acquisition. Studies are underway to determine whether CET provides added value beyond a two-dimensional CEM. As CEM utilization grows, the need for sampling lesions seen only on the enhanced images is necessary. As a result, CEM-directed biopsy was recently developed and is being incorporated into some practices. More information on its ease of use and performance will be forthcoming. Lastly, several groups are evaluating whether radiomics can improve CEM ability to detect cancers. Overall, CEM is an exciting technology that improves cancer detection with several developments on the horizon that will only add to its value in clinical practice.