Utility of routine use of breast ultrasound following contrast-enhanced spectral mammography

E. Klang, A. Krosser*, M. M. Amitai, V. Sorin, O. Halshtok Neiman, A. Shalmon, M. Gotlieb, M. Sklair-Levy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Aim: To evaluate whether breast ultrasound (US) is routinely indicated following contrast-enhanced spectral mammography (CESM). Materials and methods: Consecutive screening and diagnostic CESM examinations with concurrent breast US were collected retrospectively (May 2012 to February 2016). Radiologists assigned a separate Breast Imaging-Reporting and Data System (BIRADS) score for CESM and for US. BIRADS scores were grouped into three categories: normal/benign appearing (BIRADS 1, 2); probably benign, short-term follow-up (BIRADS 3); or suspicious appearing (BIRADS 0, 4, 5). Patients with a suspicious-appearing lesion in either US or CESM underwent biopsy. The associations between malignant pathology with either suspicious-appearing CESM or suspicious-appearing US were calculated. The sensitivities and specificities of CESM and US were analysed. Results: Eighty-seven lesions were biopsied, 37 (43%) biopsies were malignant and 50 (57%) were benign. Although suspicious-appearing CESM was associated with malignant biopsies (p<0.0001), suspicious-appearing US was not (p=0.985). Among 37 malignant biopsies, CESM had a sensitivity of 97% (36/37 lesions), compared to 92% (34/37 lesions) with US. None of the malignant biopsies were normal/benign appearing with CESM. One case of follow-up CESM was suspicious-appearing at US and proved to be malignant on biopsy. The specificity of CESM was 40%, which was significantly higher than US at 8%. Conclusion: When CESM is suspicious appearing, subsequent US and biopsy is appropriate. With a CESM BIRADS 3, correlation with US is suggested. If the CESM is benign appearing, the routine use of US is questionable, as it may lead to unnecessary benign biopsies.

Original languageEnglish
Pages (from-to)908.e11-908.e16
JournalClinical Radiology
Issue number10
StatePublished - Oct 2018


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