Could new mammography techniques be an alternative for dynamic contrast-enhanced breast MRI in the diagnosis and preoperative staging of breast lesions?

Abstract Background Breast cancer is the most common malignant tumor among women, and all the imaging modalities are used to help in the early detection and accurate diagnosis of breast abnormalities and so led to proper management. Breast tomosynthesis is one of the modifications of digital mammography that obtains 3-dimensional images and so helps in better detection and characterization of the breast lesions. Contrast-enhanced digital mammography and dynamic breast MRI are post-contrast studies that allow the detection of the neovascularization associated with breast cancer, yet MRI is still the most accepted modality that shows the highest sensitivity in the detection and diagnosis of breast cancer. This study aimed to evaluate the role of new mammographic techniques and compare them with dynamic contrast-enhanced MRI in diagnosis and preoperative staging regarding multiplicity and size assessment of breast lesions. Results This prospective study included forty female patients with 53 breast lesions that were referred to the breast unit in our oncology institute. Inclusion criteria included BI-RADS 3, 4, and 5 breast lesions, clinical indication for MRI breast, and no previous histologically proven cancer. Exclusion criteria included pregnancy, allergy to an iodinated contrast agent, renal impairment, and any contraindication for MRI. All patients were scheduled for contrast-enhanced digital mammography, single-view tomosynthesis, and dynamic contrast-enhanced MRI in another separate setting. The final diagnosis was established by pathology. Dynamic contrast-enhanced MRI showed the highest sensitivity and specificity in this study followed by contrast-enhanced digital mammography and then digital breast tomosynthesis. Combined use of the new mammographic techniques (digital breast tomosynthesis and contrast-enhanced digital mammography) increases the sensitivity and negative predictive value approaches that of dynamic contrast-enhanced MRI. Dynamic contrast-enhanced MRI showed agreement with the pathology regarding the detection of lesion multiplicity, followed by contrast-enhanced digital mammography. Conclusions The combined use of the new mammographic technique (digital breast tomosynthesis, and contrast-enhanced digital mammography) raises their diagnostic performance approaches of the dynamic contrast-enhanced MRI and may be a reasonable alternative to it; however, dynamic contrast-enhanced MRI remains the technique of the highest diagnostic accuracy in the diagnosis and assessment of breast lesions.