Authors (including presenting author) :
Chien CPY, Chin LHQ, Lau HT, Ho G, Lam TPW
Affiliation :
Department of Radiology, Queen Mary Hospital
Introduction :
Contrast enhanced digital mammography (CEDM) is a novel technique in breast imaging. It has been approved by FDA for an adjunct to mammogram and ultrasound for better lesion localization and diagnosis, and an essential alternative for patient who are contraindicated to MRI or patient who are claustrophobic. It has a higher sensitivity compared to CEDM and similar diagnostic performance compared to MRI. It is particular useful in Asian women with dense breast who are known to have reduced mammogram sensitivity due to masking effect. Its advantages are well recognized and is gaining popularity in recent years
Objectives :
1. To introduce CEDM protocol and workflow in Hong Kong West Cluster.
2. To describe and evaluate the clinical benefits of CEDM.
Methodology :
CEDM is a new imaging technique adopted in Hong Kong West Cluster since early 2021. It has been used to identify associated enhancement in patient with suspicious malignant microcalcifications for improve diagnostic accuracy and triage in management in this early adoption phase. Patients were screened for renal function and contrast allergy before the examination. Informed consent was obtained. Iodinated contrast was administered and CEDM was performed following a standardized protocol and workflow in our department. Images were interpreted by fellowship-trained breast radiologists. Complications including contrast related adverse reactions and contrast extravasation were documented. Radiation dose was recorded and monitored. Patient clinical outcomes were reviewed and retrieved
from electronic health record (ePR).
Result & Outcome :
Over 70 CEDM examinations were performed over a period of 18 months. The median age
of women was 52 (range 29-77). More than 40% of the cases showed contrast enhancing
lesions, in which around 60% of them were positive for malignancy. The total procedure time was around 15 minutes. No complications were encountered. Mean radiation dose was 2.3mGy (around 1.2-1.4 times of the digital mammography), which was well below the 3mGy average glandular dose limit specified in the Mammography Quality Standards Act regulations.
From radiologists experience, we found that it can improve diagnostic accuracy during our reporting, facilitate triage patient into further management and follow-up plan, and improve biopsy yield by targeting enhancing areas.
This new technique is also welcomed by clinicians since it provides additional information in counselling patient regarding the risks and treatment plans during clinical follow-up.
It is a much shorter procedure compared to MRI, which translates into clinical efficiency, patient comfort and satisfaction. Patient who are contraindicated to MRI or claustrophobic can benefit from this new technology
