الفهرس 
Posterior capsular pacification (PCO)Only 14 pages are availabe for public view
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Abstract
Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females worldwide. About half the breast cancer cases and 60% of the deaths are estimated to occur in economically developing countries. Logically, screening is expected to reduce the incidence of advanced cancer, followed by a reduction in breast cancer mortality.
Mammography is the only imaging modality that has been shown to reduce mortality from breast cancer through screening and early detection, but it is an imperfect tool with an overall sensitivity of 75%–85%. This is especially true in women with radiographically dense breasts due to a reduced contrast between a possible tumor and surrounding breast tissue (Lobbes, 2013).
Contrast enhanced digital mammography is an advanced application of full-field digital mammography enabling the detection of angiogenesis in breast carcinoma. CEDM should be a useful adjunct to diagnostic mammography and a promising problem-solving and staging tool.
Contrast uptake was assigned, similar to dynamic MRI, in the form of mass or non-mass enhancement. In assessment of mass lesions, the highest values were scored by mass shape description of the enhancing mass lesion, followed by the mass intensity, followed by enhancement pattern, followed by mass margin, while the lowest values were scored with presence or absence of contrast uptake. In assessment of non-mass lesions, the highest values were scored by the non-mass intensity, followed by non-mass enhancement pattern, followed by non-mass distribution, while the lowest values were scored with presence or absence of contrast uptake.
An application of interest should be the clarification of equivocal lesions on conventional imaging, particularly in follow-up after breast-conserving surgery. Also, as CEDM is able to demonstrate both morphology and tumor enhancement, it could be beneficial in the assessment of treatment response. Disappearance of the tumor enhancement after neoadjuvant chemotherapy predicts a good outcome but not essentially complete pathological response.
Calculated sensitivity and specificity of CEDM according to the above specified criteria were 88.99% and 83.33% respectively with a positive likelihood ratio of 5.34. CEDM had a better diagnostic accuracy mainly due to improved specificity, and better positive and negative predictive values.
We recommend adding CEDM as a primary assessment for patients with dense breast. It could be useful, however, to perform CEDM before US because CEDM allows more accurate localization of the lesion than mammography alone and provides better guidance for additional or second-look breast US.