The role of contrast-enhanced spectral mammography in the evaluation of the postoperative breast cancer.

AIM: To assess the utility of contrast-enhanced spectral mammography (CESM) to detect malignancy in the postoperative breast of cancer patients. MATERIALS AND METHODS: The study was a prospective analysis of 76 women following operations for breast cancer. CESM was performed with low (22-33 kVp) and high (44-49 kVp) energy exposures after intravenous injection of contrast agent. Breast abnormalities were evaluated regarding the presence, morphology, and pattern of contrast medium uptake. The reference standard was histopathology of the Tru-Cut biopsy or surgical biopsy in cases where malignancy was suspected and absence of abnormality at follow-up sessions in benign cases. RESULTS: Seventy cases were eligible for data analysis, and malignancy was detected in 48.6% (n=34/70). Enhancement at the operative bed was observed in 40 (57.14%) lesions. At traditional mammography, the diagnosis was false negative in 17/70 and false positive in 28/70 lesions, and presented a low sensitivity of 50%, a very low specificity of 22%, a positive predictive value of 37.7%, a negative predicative value of 32%, and an accuracy of 35.7%. CESM enhanced the performance of mammography and produced a sensitivity of 91.17%, a specificity of 75%, a positive predictive value of 77.5%, a negative predictive value of 90%, and an accuracy of 82.85%. CONCLUSION: CESM is a credible technique that could be used in conjunction with the traditional mammogram to screen for cancer in the postoperative breast.