الفهرس 
Introduction & Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common malignant tumor among women. The purpose of all diagnostic modalities in breast cancer is the early detection and proper diagnosis, which has major impact on further management and prognosis.
Mammography and breast ultrasound are still considered the first routine examination tools in diagnosis of breast disease worldwide, however the overlap in the mammographic and ultrasongraphic appearance of benign and malignant lesions as well as edematous and dense breast tissue especially in young patients necessitates the presence of problem solving complementary studies. Contrast enhanced digital mammography is a new breast imaging technique currently under evaluation to determine the best indications for that and to assess its possible diagnostic benefits which aim at clarification of equivocal lesions, demonstrating breast carcinoma angiogenesis ,tumor extension besides detection of multicentricity and multifocality breast lesions .
CEDM has the advantage of being a fast imaging technique, which can be performed by using a current digital mammography system with some specific software and hardware adaptations and has the advantage of being reproducible without operator dependency.
Between the two techniques of CEDM currently being investigated (the temporal subtraction technique and the dual-energy technique), the dual-energy technique offers the possibility of imaging both breasts in two views (CC and MLO) during a single injection of contrast, less sensitive to patient motion and better tolerated by the patient due to shorter examination and breast compression time.
The purpose of this study is to assess the role of dual energy contrast enhanced digital mammography in evaluation of indeterminate breast lesions (BIRADS 3 and BIRADS4) detected in conventional imaging modalities either at screening study or diagnostic imaging .BIRADS 3 probably benign ,BIRADS 4 probably malignant which have dilemma of characterizations during routine imaging diagnosis and correlate the findings with the pathology results.
Thirty patients were enrolled in this prospective study at National Cancer Institute , Cairo university .Statistical tests were performed to check the sensitivity ,specificity ,accuracy and predictive values for three imaging modalities .
All patients underwent the standard of care for diagnostic procedures (mammographic , ultrasounsonographic examinations) then referred for further contras enhanced digital mammography examination.
Compared to the standard of care for diagnostic procedures (mammography associated with complementary breast ultrasound), CEDM significantly increased the sensitivity and the specificity and diagnostic accuracy.
Contrast Enhanced Spectral Mammography showed the highest specificity compared to other imaging modalities in our study as CESM had a a specificity of 64.4%, a sensitivity of 95.2%, a positive predictive value of 80 %, a negative predictive value of 90 % and diagnostic accuracy 82.9% .So, CESM reduces false positive results. CEDM can accurately detect breast malignancy through demonstration of contrast uptake in all malignant parenchymal breast lesions with good true negative rates, thus it minimize the need to unnecessary breast biopsies.
CEDM increased the accuracy of BI-RADS assessment of malignant cases and detection of patients with multifocal and multicentertic histologically proven malignancy in the current study.
So CEDM has a higher diagnostic accuracy for the detection and characterization of indeterminate breast lesions which have dilemma of characterizations during routine imaging diagnosis compared with mammography or ultrasound alone , CEDM showed the highest specificity in our study as it reduces false positive results. So, it is used for better breast cancer determination and so has a potential role in preoperative planning .
Also, CEDM may be useful for the assessment of loco regional extension of disease as well as the clarification of equivocal, multicentric and multifocal breast lesions when used as an adjunct to other breast imaging modalities as mammography and ultrasound.