Comparison of Low-Energy Mammograms Obtained in Contrast-Enhanced Mammography With Routine Full-Field Digital Mammography in the Asian Population: An Agreement Study.

Abstract

Objective: Digital contrast-enhanced mammography (CEM) is traditionally used as an adjunct following standard full-field digital mammography (FFDM), potentially causing redundancy and unnecessary radiation exposure. Prior studies have demonstrated comparable image quality between low-energy (LE) 2D CEM and FFDM, primarily in Caucasian cohorts with less dense breast tissue. This study compares the diagnostic accuracy of LE CEM images with FFDM images in an Asian population with denser breasts.

Methods: This study enrolled 143 women (mean age 56.4 ± 10.2 years) who underwent both LE CEM and standard FFDM, primarily for diagnostic evaluation of clinically or radiologically suspicious breast abnormalities, within a 2-month interval. A total of 135 lesions (13 benign, 122 malignant) were identified. Six radiologists independently reviewed the FFDM and LE CEM images in an anonymized, sequential manner, with a washout period to minimize recall bias. Diagnostic performance metrics between LE CEM and FFDM were compared using Gwet's κ statistics.

Results: Overall agreement between LE CEM and FFDM was high (κ = 0.892, P <.001). Low-energy CEM demonstrated higher sensitivity (92.3% vs 88.5%) but slightly lower specificity (47.6% vs 52.4%) compared with FFDM for malignancy detection but was not statistically significant (P = .078 and P = .450, respectively). Notably, 23.4% of normal FFDM readings showed abnormalities on LE CEM, with 19 of these 25 cases (76%) revealing underlying malignancies.

Conclusion: In this retrospective cohort study, LE CEM showed potential as a replacement for FFDM, particularly in populations with predominantly dense breast tissue, under certain clinical circumstances.