Background: A contrast-enhanced mammogram (CEM) is a form of mammography that contains both the traditional morphologic data with the addition of physiologic information from the contrast injection and dual-energy subtraction. Indications are similar to MRI with advantages of potential for greater availability to patients, less cost, and wider patient acceptance. The interpretation is analogous to that of breast MRI. Malignancies may present as mass or non-mass enhancement, there can be overlap in the appearance of benign and malignant entities, and evaluation of morphology and margins of findings is critical. One of the advantages of CEM is that areas of enhancement can be correlated to the mammogram for calcifications and new asymmetries, masses, or distortions. There are no formal training requirements for CEM interpretation, however sharing cases and educational presentations will promote learning and increased comfort level in radiologist interpretation.
Learning Objectives: The main objective is to familiarize the radiologist with the variable presentation of malignant and benign lesions on contrast-enhanced mammography. 1. Provide multiple examples of enhancement features of invasive and non-invasive malignancies on contrast-enhanced mammography. 2. Share examples of benign lesions that may mimic malignancies on CEM. 3. Illustrate background parenchymal enhancement (BPE) levels and how they can affect interpretation.
Abstract Content/Results: The format of the content will be a pictorial review of 15 CEM cases demonstrating multiple examples of invasive ductal and lobular processes, as well as less common malignancies. Additionally, benign breast lesions that may mimic malignant processes will also be highlighted. BPE will be demonstrated from mild to significant demonstrating the additional challenges of interpretation with greater degrees of background enhancement. The cases will be accompanied by a short description of the images and pathologic findings of the case. The descriptions will provide guidance on identification of the various types of lesions and reporting terminology
Conclusion: Contrast enhanced mammography can be used as an alternative to MRI for inconclusive diagnostic evaluations, pre-surgical staging, to evaluate response to neoadjuvant chemotherapy, or post-lumpectomy surveillance. Off label use as a screening modality in high-risk individuals and patients with dense breast tissue is also gaining wide acceptance. Benign lesions, such as Pseudoangiomatous stromal hyperplasia, fibrocystic changes and complex sclerosing lesions, can mimic malignant lesions. As with MRI, biopsy is often necessary to differentiate. As radiologists are adopting this technology in their breast centers, understanding the enhancement features of both malignant and benign lesions will assist in accuracy and confidence of the radiologist.
