A new tool from contrast-enhanced mammography may help doctors predict a confusing breast cancer result before surgery. This could spare some women from waiting, worrying, and getting extra biopsies.
Breast cancer treatment often depends on a marker called HER2. Some tumors are clearly positive or negative. Others sit in a gray zone called equivocal. That means the standard test is not sure. Doctors call this IHC 2 plus. It is frustrating for patients and can delay care.
Many women with equivocal results need a second test called FISH. That test can take days or weeks. It can also mean another biopsy. Not every hospital can run it quickly. The result is more waiting and more stress.
But here is the twist. A new look at mammography images may help. Contrast-enhanced mammography, or CEM, uses a special dye to light up tumors. It shows more detail than a standard mammogram. Researchers found that patterns in and around a tumor on CEM can hint at HER2 status.
Think of a tumor as a house. The inside of the house is the intratumoral area. The yard around it is the peritumoral area. The dye acts like a floodlight. It shows how the tumor feeds and how the tissue around it reacts. Some patterns suggest a tumor is more likely to be HER2 positive. Others suggest it is not.
The study included 131 breast cancer patients with equivocal HER2 results. They were split into three groups for training and testing. Researchers extracted patterns from the tumor and the area around it on CEM images. They used smart computer methods to pick the most useful patterns. Then they built a simple tool called a nomogram. This tool combines those patterns with basic clinical facts, like tumor size.
The nomogram performed well. In the internal test group, it had an AUC of 0.893. In the prospective test group, it had an AUC of 0.840. AUC is a score from 0 to 1. A score near 1 means the tool is good at telling two groups apart. The tool also showed good calibration and decision curve results. That means its predictions matched real outcomes and helped guide decisions.
This does not mean this tool is available in your hospital today.
The study suggests that CEM patterns could help doctors decide who needs a second test and who might not. It could shorten the path to a clear answer. It might reduce the number of repeat biopsies. It could also help teams plan surgery sooner.
An expert perspective is not included in the abstract. Still, this work fits a growing trend. Radiologists are using computer-based image analysis to support clinical decisions. The goal is not to replace doctors. It is to give them better tools to care for patients.
What does this mean for you right now. If you have an equivocal HER2 result, ask your care team about CEM. Not every center offers it yet. It is not a substitute for standard testing. It is a possible aid to help guide next steps. Talk with your doctor about whether it might fit your situation.
The study has limits. It included a small number of patients. The tool needs larger, multi-center trials. It also needs testing in real-world clinics over time. Not every tumor looks the same, and not every hospital uses the same equipment.
What happens next. Researchers will likely test this nomogram in more patients and more hospitals. They will compare it to standard care and see if it truly shortens time to treatment. If results hold, the tool could be built into CEM software. That could make it easier for doctors to use in daily practice.
