Background: Contrast-enhanced digital mammography (CEDM) is a new breast imaging technique. The role of CEDM in the surgical management of breast cancer has not yet been characterized. Methods: A retrospective review of prospective breast surgery and breast imaging databases for patients who underwent CEDM and had breast cancer surgery. Results: A total of 351 patients had CEDM; 128 had malignant lesions, and 101 of these underwent surgery with 105 malignancies identified. The mean age was 62 years (range 25–85 years). The histology was 65 % invasive ductal carcinoma, 16 % invasive lobular carcinoma, 11 % ductal carcinoma-in situ, 3 % mixed invasive ductal carcinoma/invasive lobular carcinoma, and 5 % other histologies. After excluding two lesions that had been removed before the examination, CEDM identified 98 % (n = 101/103) of the index lesions. The two lesions not identified were Paget disease only and a parasternal lesion too medial to include in the field of view. CEDM led to additional biopsies in 12 % (n = 12) of patients. Of these, 67 % (n = 8) proved to be invasive carcinoma and 33 % (n = 4) were benign. CEDM changed surgical management in 20 % (n = 20) of cancer patients with a 4 % (n = 4) rate of conversion to mastectomy. Conclusions: Among patients undergoing surgical therapy for breast cancer, CEDM was highly sensitive, had size measurements that correlated well with histologic size, and produced a relatively low rate of false-positive additional biopsy findings. CEDM appears to be promising as an alternative to magnetic resonance imaging in the surgical planning of these patients.
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