Summary: A study in the American Journal of Roentgenology found that mean glandular dose was higher for contrast-enhanced mammography than for full-field digital mammography (FFDM) or digital breast tomosynthesis (DBT) alone but lower than combined FFDM-DBT, supporting its use in screening women at elevated breast cancer risk.

Key Takeaways

  • Comparative MGD Findings: Mean glandular dose (MGD) was higher for contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) or digital breast tomosynthesis (DBT) alone but was lower than the combined FFDM-DBT dose.
  • Study Population and Methods: The study analyzed 764 breasts from 389 women at elevated breast cancer risk, evaluating craniocaudal and mediolateral oblique views for each imaging method and extracting MGD values and BI-RADS density categories.
  • Clinical Implications: The findings support the role of CEM in breast cancer screening, particularly for women at higher risk or with dense breast tissue, due to its effective balance of diagnostic performance and radiation dose.

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An intraindividual comparative study published in the American Journal of Roentgenology (AJR) evaluated mean glandular dose (MGD) per breast across full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and contrast-enhanced mammography (CEM). The findings showed that MGD was higher for CEM than for FFDM or DBT alone.

“However, these differences were small, and MGD was lower for CEM than for combined FFDM-DBT,” says first author Jeremiah W. Sanders, PhD, assistant professor of medical physics at Mayo Clinic in Phoenix.

Breast Imaging Methods in High-Risk Women

The study analyzed data from 389 women (median age: 57.4 years) at elevated risk of breast cancer, who underwent combined FFDM-DBT and CEM screening as part of a prior clinical trial between February 2019 and April 2021. A total of 764 breasts (383 left, 381 right) were evaluated, with craniocaudal and mediolateral oblique views assessed for each imaging method. MGD values were extracted from DICOM metadata, and BI-RADS breast density categories were obtained from clinical radiology reports. Effective doses were also calculated.

Median MGD per breast was 4.07 milligray (mGy) for FFDM alone, 4.97 mGy for DBT alone, 9.38 mGy for combined FFDM-DBT, and 5.87 mGy for CEM. Corresponding effective doses were 0.49 mSv, 0.60 mSv, 1.13 mSv, and 0.70 mSv, respectively.

“This intraindividual comparative study informs discussions of the role of CEM in breast cancer screening for women at elevated risk or with dense breasts,” the authors concludes.

Featured image: A) full-field digital mammography (FFDM), (B) digital breast tomosynthesis (DBT), (C) combined FFDM-DBT, and (D) contrast-enhanced mammography. Each plot shows data further stratified by breast density category and with accompanying exponential trend-lines; to aid visualization, plot for DBT (B) does not depict trend-lines, which were similar with one another and overlapped with data points. Equations for trend-lines are: (A) MGDB = 0.6124e0.01624T, MGDC = 0.6070e0.01922T, and MGDD = 0.5647e0.02309T; (C) MGDB = 1.3880e0.01719T, MGDC = 1.2240e0.02021T, and MGDD = 1.1970e0.02228T; and (D) MGDB = 1.0770e0.01415T, MGDC = 0.8987e0.01866T, and MGDD = 0.8524e0.02214T.