Can Contrast-Enhanced Mammography Improve Positive Predictive Value for Diagnostic Workup of Suspicious Findings? A Single-Arm Prospective Study.

OBJECTIVE

To assess the positive predictive value-3 (PPV3) and negative predictive value (NPV) of contrast-enhanced mammography (CEM) when added to the diagnostic workup of suspicious breast findings.

METHODS

This prospective study was IRB approved. We recruited 99 women with abnormal findings on digital breast tomosynthesis (DBT) and/or US to undergo CEM prior to biopsy. Based on final pathology outcomes, PPV3 and NPV were calculated and compared using N-1 chi-squared tests with P-values and 95% CIs.

RESULTS

Final pathologic outcome yielded 56.6% (56/99) benign, 5.1% (5/99) benign with upgrade potential (BWUP), and 38.4% (38/99) malignant lesions. Final pathologic outcomes for the 63 positive CEMs yielded 33.3% (21/63) benign, 6.3% (4/63) BWUP, and 60.3% (38/63) malignant lesions. Adding CEM to the diagnostic workup significantly increased PPV3 from 38.4% (38/99) to 60.3% (38/63) (P <.01; 95% CI, 6.1-36.2). Negative predictive value was 100% (36/36) for CEM, 92.9% (13/14; P = .1; 95% CI, -4.2 to 31.4) for DBT, and 75.9% (22/29; P <.05; 95% CI, 8.8-42.1) for US. The number of unnecessary biopsies could be reduced by 36.4% (from 100% [99/99] to 63.6% [63/99]).

CONCLUSION

Adding CEM to the diagnostic workup of suspicious breast findings could improve PPV3 to prevent unnecessary biopsies.