الفهرس 
NORMAL ANATOMY OF THE BREAST AND MAMMOGRAPHIC APPEARANCEOnly 14 pages are availabe for public view
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Abstract
Breast cancer is one of the most common types of cancer.
Despite major advances in mammography, at least 10-20% of breast
cancers can go undetected using screening mammography alone.
The accuracy of mammography is especially limited in
dense breasts where the surrounding fibroglandular tissue
decreases the conspicuity of the lesions. Even when lesions are
detected the full extent of the disease may not be clearly depicted.
Ultrasound is a complementary technique for mammography
especially for dense breasts, but US examinations are time
consuming and operator dependant.
Contrast-enhanced MRI is currently the most sensitive
breast cancer detection technique, though it has high false positive
rate and still carries the burden of high cost and low availability.
Various techniques are being developed to minimize the risk
of overlooking lesions in women with dense breasts. CEDM is a
new technique, currently under evaluation to determine the best
indications for it and to assess its possible diagnostic benefits.
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 dualenergy
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.
Studies demonstrate that there can be a diagnostic gain
achieved by combining dual-energy CEDM with conventional
mammography especially in women with dense breasts. Some
tumors were only detected with the help of contrast
mammography.
Compared to the standard of care for diagnostic procedures
(mammography associated with breast ultrasound), CEDM had a
better diagnostic accuracy due to improved sensitivity and due to
the significant reduction in the number of false negatives
compared to mammography alone. We note that it’s still difficult
to differentiate between benign and malignant tumors on basis of
enhancement, as is usual in MRI, which may be improved in the
future with the development of standardized diagnostic criteria
and imaging protocols for CEDM.
Studies hint that similar to breast MRI, CEDM could be of
particular interest for the assessment of the local extent of the disease. Actually in our study, dual-energy CEDM detected
multifocal breast cancers in all cases and allowed more accurate
lesion size evaluation.
In conclusion CEDM has the potential to increase the
cancer detection rate, to improve staging and to improve the
selection of patients for biopsy. Moreover it can be used for better
assessment of recurrent disease and for monitoring of the response to chemotherapy.