Contrast-Enhanced Mammography Versus Dynamic Contrast-Enhanced MRI in the Evaluation of Sonomammographic BI-RADS 3 &4 Breast Lesions

Background Breast cancer is a major health problem and a leading cause of death. Early detection of breast cancer aims to reduce morbidity and mortality rates. Mammography has been established as the imaging modality for screening and early detection of breast cancer; however, it has low sensitivity and specificity in women with dense breasts. Nowadays, MRI of the breast is used as a problem-solving tool. Aim of the Work To assess and compare the diagnostic value of contrast-enhanced mammography and dynamic contrast-enhanced MRI in the evaluation of BI-RADS 3 and BIRADS 4 lesions detected in conventional imaging modalities (Mammography and US). Patients and Methods The study was conducted at Ain Shams University & National Cancer Institute (N.C.I). Thirty patients with no age predilection were enrolled in this study. The patients who presented with BI-RADS 3 and 4 lesions diagnosed by mammography and sonomammography were assessed by both contrast-enhanced digital mammography (CEDM) and dynamic contrast MRI (DC-MRI) mammography with the maximum dimensions of the lesion or lesions measured in both studies and correlation with histopathology was conducted. Results We found that the area under the curve of DC-MRI was of the highest value (AUC: 88.3%) followed by that of CEDM (AUC: 82.5%). Both were significantly superior to the area under the curve of sonomammography (AUC: 72.9%) and mammography (AUC: 67.1%). Conclusion CEDM and DC-MRI have higher diagnostic accuracy for the detection of intermediate breast lesions compared with mammography alone and with mammography interpreted in association with sonography. CEDM showed slightly lower sensitivity and accuracy compared to DC-MRI. However because of being relatively easier, available, cheap, and acceptable by women, CEDM be used as a problem-solving tool in the characterization of indeterminate breast lesions.