Contrast-enhanced mammography (CEM), also known as contrast-enhanced spectral mammography (CESM) or contrast-enhanced digital mammography (CEDM), is an advanced breast imaging technique that combines traditional mammography with intravenous contrast agents.
The innovative approach offers a more detailed view than traditional mammography to improve the detection and characterization of breast abnormalities, particularly in people with dense breast tissue. It’s also particularly beneficial in identifying and evaluating areas of increased blood supply often associated with tumors. The CEM procedure is similar to a standard mammogram but with the addition of a contrast agent. It is a non-invasive procedure and usually takes about 30 minutes to complete.
Continue reading to learn how contrast-enhanced mammography works, who should consider CEM, the benefits of CEM, and its potential risks and considerations.
How Does Contrast-Enhanced Mammography Work?
CEM involves administering an iodine-based contrast agent during the mammogram. The contrast agent increases the visibility of blood vessels and enhances the contrast between normal and abnormal tissues. The procedure includes taking two sets of mammographic images—one before and one after the contrast injection—allowing radiologists to compare and detect changes more effectively.
Who Should Consider Contrast-Enhanced Mammography?
CEM is particularly useful for:
People with dense breast tissue
People with inconclusive results from conventional mammography or ultrasound
Individuals at high risk for breast cancer
Benefits of Contrast-Enhanced Mammography
Improved Cancer Detection
One of CEM’s strengths is its enhanced diagnostic capability to detect cancers that may remain undetected in standard mammograms. With traditional mammography, tumors and dense tissue have a similar white appearance, leading to potential misinterpretations or overlooked cancerous lesions.
The contrast agent injected for CEM highlights the cancerous areas more, making it easier to differentiate between benign and malignant lesions. This reduces the need for unnecessary biopsies and provides a more accurate diagnosis and treatment planning.
Accurate and Earlier Diagnosis
CEM provides clearer images, allowing radiologists to detect abnormalities with greater accuracy. It’s particularly important in the early detection of breast cancer, where identifying small tumors can be challenging with standard imaging techniques. Early detection is crucial, as it significantly increases the chances of successful treatment and survival.
CEM is also pivotal in staging breast cancer, which determines the extent of the disease. Detailed images help identify the size of the tumor, its location, and whether it has spread to adjacent tissues or organs. This information is vital for clinicians to develop an effective treatment plan, tailor therapies to the patient’s specific condition, and predict the likely course of the disease.
Evaluation of Treatment Response
CEM helps healthcare providers obtain a clearer picture of how the tumor is responding to chemotherapy — whether it’s shrinking, remaining stable, or growing. This information is vital for planning the next steps in the treatment process.
For example, if the tumor responds well and shrinks significantly, a patient might be eligible for less extensive surgery, potentially preserving more of the breast tissue. Conversely, if the tumor does not respond adequately, adjustments to the chemotherapy regimen or a reevaluation of treatment options might be necessary.
Reduced Radiation Exposure
CEM distinguishes itself from other advanced methods, such as breast X-rays, by employing lower doses of radiation. It’s particularly significant because it makes the technique a more viable option for routine breast screening. While advanced imaging methods like breast X-rays provide detailed insights, they often require higher levels of radiation or the use of other forms of energy, which can be a concern for patients undergoing regular screenings.
Reduced radiation exposure decreases the potential risk of radiation-induced complications, aligning with the principle of minimizing radiation dose as much as possible while still achieving high-quality imaging results.
Comparing CEM With Other Breast Imaging Techniques
While traditional mammography remains a gold standard for breast cancer screening, CEM offers additional benefits, especially in complex cases. According to the National Institutes of Health, CEM is quicker and more cost-effective than MRI, though each modality has unique advantages depending on the clinical scenario.
Risks and Considerations
While CEM offers improved sensitivity and specificity in detecting breast lesions compared to conventional mammography, it also carries certain risks. Intravenous contrast agents introduce the possibility of allergic reactions, ranging from mild to severe, though such reactions are rare.
Additionally, there is a risk of nephrotoxicity, where the kidneys could be adversely affected by the contrast medium, especially in patients with pre-existing kidney conditions.
As with any form of mammography, there is also exposure to a low level of ionizing radiation, which carries a small risk of inducing cancer. It’s essential to balance these risks against the potential benefits of CEM, especially in complex diagnostic situations or for individuals at high risk for breast cancer. Patients should discuss their medical history and any allergies with their healthcare provider.
Count On Us for Information, Resources, and Support
Contrast-enhanced mammography represents a significant advancement in breast imaging, offering enhanced detection and characterization of breast lesions. By providing more detailed information, CEM plays a crucial role in the early diagnosis and treatment planning for breast cancer.
Whether you’re newly diagnosed with breast cancer, are navigating survivorship, or are the loved one of someone experiencing breast cancer, you can count on SurvivingBreastCancer.org to keep you informed. We provide educational information to help you better understand symptoms, testing, treatment options, surgery, etc., and podcasts that feature professionals, advocates, and caregivers who share valuable information.
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Note: This article is designed to provide general information and is not meant to replace professional medical advice. Always discuss your options with your healthcare provider.
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