الفهرس 
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Abstract
S
urvival from breast cancer has improved over the past three decades, resulting in a growing population of survivors at risk for local recurrence or second primary breast cancer. While rates of local recurrence have also continued to decline secondary to improvements in the loco-regional management and effective systemic therapies, women treated with breast-conserving surgery (BCS) still have a risk for tumor recurrence with rates that vary by tumor subtype and stage. Thus, an increasing number of breast cancer survivors, including those who have been treated with BCS, need post-treatment imaging surveillance.
A yearly mammography is recommended by the American Society of Clinical Oncology (ASCO) and American College of Radiology (ACR) guidelines for women who have been treated for breast cancer, as it has been demonstrated to improve survival. While early detection is crucial for improved survival, a mammography may be less sensitive in the post-surgical breast compared to the non-treated breast, given that post-treatment changes (including fat necrosis, surgical distortion, metallic clips, and scars) can obscure cancers on screening mammography.
Contrast-enhanced spectral mammography (CESM) has emerged as a potential alternative method to MRI. CESM is a combined evaluation of anatomy with low-energy (LE) images (equivalent to a routine full-field digital mammogram (FFDM)) and an enhancement of vascularity with recombined images. CESM has been shown to be particularly valuable in women with dense breasts.
from June 2019 to July 2023, we conducted our study on 30 patients with indeterminate lesions following conservative breast surgery. All patients were subjected to CESM (both low- and high-energy images) and ultrasound examinations. Evaluation of lesions’ side, shape, definition, consistency, presence of calcifications and architectural distortion, vascularity on both CESM and Doppler mode and state of the residual lymph nodes was performed. Grading of the findings was done as regard ACR, BIRADS and MPS scales. The results were compared to histopathological findings.
Therefore, contrast-enhanced spectral mammography (CESM) is recommended as an adjunct to digital mammography for assessment of indeterminate breast lesions in patients with breast conservation surgery.