Diagnostic value of contrast-enhanced mammography in the characterization of breast asymmetry

Background: Breast asymmetry is a prevalent mammographic finding described in BI-RADS atlas as asymmetry, focal asymmetry, global asymmetry, and developing asymmetry. Mammography has a limited role in discrimination between benign and malignant asymmetry, and digital mammography can overlook up to 15-30% of breast tumors. The purpose of our study was to assess the role of contrast-enhanced mammography (CEM) in distinction between benign and malignant asymmetries. Results: Out of the studied 540 indeterminate and suspicious asymmetries, and according to final histopathological results, 97/540 (17.9%) asymmetries were benign, 395/540(73%) asymmetries were malignant, 48/540 (8.9%) asymmetries were normal with no underlying pathology. After comparing results of sonomammography and CEM, CEM showed higher sensitivity (96.5% vs. 85.8), specificity (77.1% vs. 64.4%), NPV (88.8% vs. 62.7%), PPV (92.04% vs. 86.7%) and accuracy (91.3% vs. 80%). Conclusions: CEM has proven to be a valuable and beneficial imaging technicality for patients and radiologists, with breast cancer detection sensitivities superior to that of full-field digital mammography (FFDM) with ultrasonography (US).