الفهرس 
ANATOMY OF THE BREAST
ACR classification of breast densityOnly 14 pages are availabe for public view
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Abstract
Breast cancer is not only a leading cause of death among women but also carries a high risk of recurrence. Early detection of local recurrence of breast cancer has been shown to significantly improve long term survival. Women with a history of breast cancer are at risk for developing local recurrences, a second ipsilateral breast cancer, or contralateral breast cancer. The incidence of local recurrence is between 1 and 2% per year, with most of the recurrences occurring in the first 5 years.
Both breast surgeries and radiotherapy can produce scarring with architectural distortion. This architectural distortion and increased density at the operation site as well as post-treatment edema may impair accurate detection of recurrence on mammography and ultrasound. Thus differentiating those expected post operative and related treatment changes from true recurrence on physical examination as well as on post-treatment breast imaging can sometimes be challenging.
The accurate assessment of residual tumor after neoadjuvant chemotherapy is a crucial prognostic factor for determining outcome and likely survival of the patient. Overestimation of residual tumor will lead to a prolonged chemotherapy course and/or an unnecessarily wide resection. However, how to perform a successful BCS after NAC is challenging. It is difficult to how much tissue should be removed, especially in patients who responded well to the treatment. Accordingly, a number of studies evaluating the capability of imaging for monitoring response to chemotherapy have been conducted.
The introduction of full-field digital mammography has sparked the development of other techniques that are less expensive than MRI and more widely available. One of these is contrast-enhanced spectral mammography (CESM) that improves the sensitivity for breast cancer detection without decreasing specificity as it provides higher contrast and better lesion delineation than mammography alone.
CESM is an imaging technique combining digital mammography with intravenous injection of iodinated contrast media to detect hypervascularized lesions. Addition of iodinated contrast agent to Mammography facilitates the visualization of breast lesions.
As CESM is a new breast imaging modality. Most studies apply the MRI lexicon. Preliminary results with CESM examination suggest that, similar to breast MRI, CESM should be of particular interest for the assessment of the operative bed site and the differentiation between malignancy and common benign post-operative changes than sono-mammography alone. Also CESM is an emerging imaging tool that is currently under evaluation to determine its diagnostic potential. To date not many studies have evaluated the value of using CESM in monitoring the response to NAC. A recent study was conducted comparing CESM and DCE-MRI in the assessment of response to NAC; its results showed that CESM seems as reliable as MRI in assessing the response to NAC, with encouraging results.
This study was prospectively carried on 69 post treated female patients either presenting with history of previous breast surgery on either breast sides, or received NAC who require follow up. It included 63 post-operative patients and 6 patients on NAC. The results were studied and correlated.
CESM in our study showed better diagnostic performance compared to mammography alone. CESM had a sensitivity of 75.7%, a specificity of 93.3%, a positive predictive value of 77.7%, a negative predictive value of 92.5%.
So, CESM seems to be a promising tool for increasing the sensitivity of conventional methods, with a performance comparable to that of MRI, it might be expected to improve size estimation and staging.
In conclusion; our results show that CESM as an adjunct to mammography is expected to improve diagnostic accuracy especially in post treated breast cancer compared to mammography alone.