Background: Breast asymmetry is a common mammographic finding which encompasses a diversity of possibilities. It may be the only sign for underlying malignancy. Contrast enhanced mammography (CEM) can reveal the asymmetry underlying angiogenesis, allowing for proper diagnosis, clinical management, reducing the number of unnecessary biopsies and increasing the rate of cancer detection. At this study we aimed to assess the performance of contrast enhanced mammography in the evaluation of different types of mammographic asymmetry.
Methods: This is a prospective study approved by our institutional review board. The study included 36 consecutive females whose mammograms revealed any type of mammographic asymmetry. After obtaining patients' informed consents, contrast enhanced mammography (CEM) examination was performed. Low energy and combined images were analyzed using the newly published contrast enhanced mammography (CEM) attachment to ACR BI-RADS® Mammography 2013 in 2022 followed by BIRADS categorization. Ultrasound was performed for all cases to verify the BIRADS category. Final diagnosis established by Ultrasound and follow-ups for benign lesions. Malignant and suspicious lesions on CEM or ultrasound were biopsied.
Results: The performance of CEM in the detection of malignant breast lesions underlying breast asymmetry in correlation to final diagnosis was as follows: sensitivity was 94.44% with 83.33 % specificity and 88.89% accuracy.
Conclusion: CEM is reliable for unravelling breast asymmetry underlying pathology. Analysis of low energy and combined images aids in the characterization of underlying asymmetry, directing proper clinical management and increasing cancer detection rates.
Keywords: Asymmetry; Contrast enhanced mammography; CEM