Prior mammograms were conducted inand Figure 1.
Successful Clinical Experience By Background There have been many recent advancements in breast imaging. In particular, screening tomosynthesis has been shown to improve cancer detection while decreasing recall rates.
The advent of tomosynthesis-guided biopsies allows us to completely evaluate lesions detected on these new technologies.
As impressive as these recent advancements are, their gains are mainly in the area of increasing the sensitivity and specificity of screening exams for the detection of breast cancer detection.
As we know, functional imaging yielding data about the physiologic activity of a lesion such as that given by dynamic contrast enhanced breast MRI or PET imaging has historically been unavailable in the mammographic modality. This has been particularly frustrating, given that mammography is the only modality that frequently offers radiologists multiple prior examinations by which to establish stability of findings—which often obviates the need for further work up or biopsy of lesions.
However, things are changing. Contrast mammography, which uses standard iodinated contrast agents, can now be used in conjunction with mammography equipment to answer physiologic questions about a breast lesion that breast MRI has historically answered.
Published studies have shown contrast mammography to have equal or near equal sensitivity to MRI, but with higher specificity. The exam can generate a 2D contrast image or a 2D contrast image combined and co-registered to a tomosynthesis dataset.
We perform both types of imaging in our practice, depending on the case. About Our Practice We are a small breast clinic located in Southern Kentucky that serves 8, patients per year with both screening and diagnostic imaging services. In our rural geographical area, MR breast imaging has historically been challenging because there is no immediate access to high-quality breast MRI.
We wanted to offer accessible, accurate, and affordable services to our patients in need of contrast-enhanced imaging, and we needed the capacity to biopsy suspicious lesions that we discovered.
Our challenge, like most practices, is providing value-based care.
We began using CE2D in the September of in order to expand our range of services and offer better, cost-effective care to patients.
Since then, we have used CE2D in a variety of clinical applications that historically would have been evaluated with MRI. Specifically, we have used CE2D for the evaluation of patient-reported palpable regions of concern that were radiographically normal on diagnostic work-up, patients with pacemakers, patients with breast cancer to evaluate for extent of disease, radiology pathology discordance, claustrophobia, the uninsured, the underinsured and those with no access to transportation to outside facilities with MRI.
It has been remarkably clinically effective to use one single modality to perform digital mammography, breast tomosynthesis, tomosynthesis-guided biopsy, and contrast imaging.
How It Works The procedure can be broken down into two steps: The contrast agent is a standard non-ionic CT contrast agent that is delivered intravenously to a patient using a power injector. After waiting two minutes for the contrast agent to distribute into the breast, CE2D imaging proceeds.
One can image either one or both breasts in any projection desired.
For each projection, the system takes 2 separate but nearly simultaneous exposures, the first image is a standard 2D mammogram and the second a high kV mammogram. These images are subtracted automatically, resulting in a CE2D image that highlights any focal areas of enhancement.
If desired, the tomosynthesis series can be acquired as part of the contrast imaging protocol. The entire procedure takes less than 10 minutes and is broken out as follows.
The patient is seated. After 2 minutes, we begin positioning the patient standing. We have an approximately 6-minute window where the contrast agent can be well visualized.
In that time we can easily perform CC and MLO images of both breasts, and if desired, additional projections to show enhancement to best advantage.
Specifically, we have used CE2D to evaluate discordant radiographic and pathologic findings. Imaging Results Screening mammogram demonstrates a 0. Ultrasound US illustrates this as a 0. Tomosynthesis also demonstrates a 0.Contrast-enhanced (CE) breast imaging involves the injection contrast agents (i.e., iodine) to increase conspicuity of malignant lesions.
CE imaging may be used in conjunction with digital mammography (DM) or digital breast tomosynthesis (DBT) and has shown promise in improving diagnostic specificity. Used in a diagnostic fashion as an adjunct to mammography, the application of contrast-enhanced digital breast tomosynthesis to breast lesion evaluation may be a potential alternative tool for breast lesion morphologic and vascular characterization.
The method, known as contrast-enhanced dual energy mammography, works with X-rays of different energy levels, which are attenuated to different extents by breast tissue and the iodine contrast agent.
New technologies for breast cancer screening include low-dose mammography, contrast-enhanced mammography, tomosynthesis, automated whole breast ultrasound, and magnetic resonance imaging.
Optimal breast cancer screening will require a personalized approach, with selective application of screening technologies best suited to the individual's age.
Breast Imaging Technology. There are risks and benefits to each technology and a woman’s personal screening plan should always be developed in partnership with her healthcare provider. The American College of Radiology (ACR) is the premier source of radiology information and resources.
New ACR Contrast Reaction Card Can Help Improve Management of Contrast-Related Adverse Events Read More. February 02, Statement on Breast Tomosynthesis.
Statement on FDA Radiation Reduction Program. See More Position Statements.