Does contrast-enhanced mammography have high specificity for detecting malignancy?

Contrast-enhanced mammography (CEM) is a type of breast imaging that uses an injected contrast agent to highlight blood flow and vessel growth. This technique helps doctors see the difference between normal tissue and potentially cancerous growths by focusing on how tumors develop new blood vessels.

In clinical practice, CEM is used to evaluate suspicious areas, such as mammographic asymmetries (areas that look different on a standard X-ray). While it is highly effective at identifying potential cancer, its ability to specifically rule out benign conditions varies.

What the research says

A meta-analysis of several studies involving over 1,200 women found that CEM has a high sensitivity of 97% for detecting malignancy in mammographic asymmetries ¹. Sensitivity refers to the test's ability to correctly identify people who have cancer. However, the same study reported a specificity of 80% for these cases ¹. Specificity is the test's ability to correctly identify those who do not have cancer.

Other research indicates that CEM has strong diagnostic performance in detecting cancer and may even show higher sensitivity than some other imaging methods while having fewer false positives ⁶. Some studies suggest that quantifying how much a lesion enhances with contrast can improve the accuracy of the test when trying to tell the difference between malignant (cancerous) and benign (non-cancerous) tissue ⁷.

What to ask your doctor

• How does the specificity of contrast-enhanced mammography compare to other imaging methods for my specific case?
• Can CEM help reduce the number of unnecessary biopsies for suspicious areas found on a standard mammogram?
• In what situations is CEM most useful for distinguishing between benign and malignant findings?
• What are the advantages of using CEM in patients with dense breast tissue?