Contrast-enhanced mammography and preoperative magnetic seed placement in breast cancer patients for the detection of residual disease following neoadjuvant systemic therapy

Purpose

Assess whether contrast-enhanced mammography (CEM) enables an evaluation of the residual size of breast tumours following neoadjuvant systemic therapy (NAST) in patients initially marked with magnetic seed.

Materials and methods

This single-centre prospective study was performed between March 2022 and April 2023 with patients with invasive breast carcinoma and lesional marking with magnetic seed. CEM was performed before and after NAST. The lesion size in CEM after NAST was compared to the pathological examination after surgery. Differences between sizes were evaluated and we determined the diagnostic capability indices.

Results

The breast lesions marked with magnetic seed were successfully localised in the preoperative stage for the 42 patients included in the study and selective surgical excision was also achieved in all cases. Tumour diameter after NAST was determined by comparing enhancement on combined CEM images from before and after NAST. The mean diameter was 13.6 mm while post-surgical pathological examination determined the mean diameter to be 12.9 mm. There were therefore no statistically significant differences between the measurements.

Conclusions

There is a positive correlation and similarity between CEM and pathological examination with regards to the detection of residual disease after NAST, with high specificity and PPV.