الفهرس 
Radiological anatomyOnly 14 pages are availabe for public view
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Abstract
Breast density has been established as an independent risk factor for breast cancer. Moreover, cancers diagnosed in women with dense breasts tend to be more advanced at time of diagnosis compared to women with fatty breasts. Furthermore, the sensitivity of mammography is lower in women with dense breasts. Decreased sensitivity in denser breasts is attributable to the concept of masking. Cancers have similar x-ray attenuation as dense fibro glandular tissue, resulting in obscuration of the tumor. With this limitation, supplemental screening modalities have been investigated.
Currently, Breast imaging is undergoing major change with the wide spread use of full field digital mammography equipment.
Digital mammography has improved sensitivity compared to film-screen mammography and should be widely used in women with dense breasts.
Ultrasound tends to perform better than mammography in dense breast tissue as it detects significantly more early stage, invasive breast cancers than screening with mammography alone, leading to acceptably low interval cancer rates.
Contrast enhanced spectral mammography is a relatively new diagnostic technique that is superior to conventional mammography as it provides functional assessment of pathological neo-angiogenesis which is additional to morphological findings.
In our study, we evaluated the impact of breast Ultrasound versus Contrast Enhanced Spectral Mammography (CESM) in the detection and diagnosis of lesions in the mammography dense breasts.
50 patients with 53 breast lesions were evaluated by the two modalities. Each lesion was assigned an independent BIRADS score for each modality. The results were studied and correlated.
Breast Ultrasound had a sensitivity of 88%, a specificity of 65%, a positive predictive value of 81%, a negative predictive value of 12%, and diagnostic accuracy of 79%.
So, Ultrasound should be used in women with dense breast parenchyma as it reduces false negative results, detect solid and cystic lesions, asses and characterize the nature of the lesion as benign or malignant.
CESM had a sensitivity of 97%, a specificity of 65%, a positive predictive value of 82%, a negative predictive value of 93%, and diagnostic accuracy of 85%.
CESM is important in detection of occult lesions in mammographically dense breasts, determining loco regional extent, and in assessing multi-centricity or multi-focality in breast cancer and giving easily available and clinically useful information
CESM revealed superior diagnostic accuracy and higher sensitivity than ultrasound and hence, permitted better detection of malignant lesions. CESM found lesion enhancement in some benign lesions, as well, yielding a rate of false-positive diagnoses similar to that of Ultrasound. CESM can be performed in routine practice changing the diagnostic, and further, the treatment strategy.
Bilateral CESM is feasible, easily accomplished and well tolerated. CESM might be an alternative imaging method for MRI, especially when MRI availability is limited. CESM is cost effective, easily feasible and radiation dose is a minor drawback as it is only slightly higher than for conventional mammography. Future studies should investigate the performance of CESM in larger population groups to evaluate the diagnostic accuracy of this promising imaging method particularly in women at high risk and women with dense breasts.