الفهرس 
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Abstract
With over a million new cases in the world each year, breast cancer is the most common malignancy in women. An asymmetry is an area of increased density in the breast in mammography, when compared to the corresponding area in the opposite breast. The BI-RADS Atlas describes four types of asymmetries: asymmetry, focal asymmetry, global asymmetry, and developing asymmetry. Detection and diagnosis of asymmetries are challenging because they often are subtle and appear like typical fibro glandular tissue in the breast. Up to date breast cancer screening and primary diagnosis is done using digital mammography (DM). However, DM can miss up to 15-30% of all cancers. In DM the normal breast tissue overlap can obscure cancer or create a false negative impression of cancer. Contrast-enhanced mammography (CEM) is an emerging breast imaging modality in which the intravenous administration of an iodine-based contrast agent, combined with mammography, is used to increase the diagnostic accuracy of full-field digital mammography (FFDM). It benefits from being non-invasive, allowing visualization of the extent of disease and its angiogenic properties. Because breast asymmetries are one of the most challenging mammographic findings to evaluate, the aim of this work is to evaluate the diagnostic role of CEM in the differentiation between benign and malignant breast architectural asymmetries detected on mammograms. This study is carried out in the Department of Radiodiagnosis at Cairo University Hospitals, included 513 females’ patients presented with 540 indeterminate and suspicious asymmetries with and without an ultrasound correlate. Twenty-seven patients had multiple lesions: 7 patients had 2 asymmetries in the same breast and 20 patients had bilateral asymmetries. Patients with impaired renal functions, known allergic reaction to contrast material, and pregnant women were excluded from our study. The patients ’ age ranged from 19 age to 73 years, a mean age of female patients is 47.9 ± 9.09, who were subjected to history taking, general and breast local examination, sonomammography and contrast enhanced mammography examination. The final diagnosis of patients based on CEM compared to core or surgical biopsy results. In the studied 513 patients we found that symptomatic cases were 403/513, 78.5% and the most common clinical presentations was breast mass (217/513) 42.3% and the least complaint was nipple discharge (5/513) 1%. Some of our studied patients had presented by more than one complaint. There was a significant correlation between symptoms and malignancy (P <0.001). Breast mass presentation was more in malignant cases (201/395) 50.8%. In the reporting, there was a description of the morphological findings and enhancement characteristics, included asymmetry type, location, and associated findings. Finally, based on the morphological and enhancement features, an overall assessment of the lesion was given one of the American College of Radiology (ACR), Breast Imaging-Reporting and Data System BIRADS categories and compared it with sonomammography finding and the pathology as well. According to final histopathological results 97/540 (17.9%) asymmetries were pathologically proved benign, 395/540(73%) asymmetries were pathologically proved malignant, 48/540 (8.9%) asymmetries were normal with no underlying pathology. When compared to sonomammography, CEM showed higher sensitivity (96.5% vs. 85.8), specificity (77.1% vs. 64.4%) NPV (88.8% vs. 62.7%), PPV (92.04% vs 86.7%) and accuracy (91.3% vs. 80%).