CONTRAST ENHANCED MAMMOGRAPHY
What is contrast enhanced mammography?
A Contrast Enhanced Mammogram (CEM) examination provides additional information beyond a conventional mammogram, and may result in earlier detection of cancers not visible on a standard 2D or 3D mammogram. CEM can be performed with tomosynthesis (3D mammogram) at the same time. A CEM exam uses contrast dye containing iodine (the same dye as used in CT scans). This dye makes it easier to find new blood vessels that develop in cancers when they grow.
Why might I need a CEM?
Your doctor may recommend that you have a CEM exam for:
• Screening for breast cancer. CEM may be useful especially for women who are at increased risk for developing breast cancer, for women who have dense breasts and as a viable alternative to MRI breast.
• Evaluating any lumps in your breast(s) that were found during a physical exam.
What to expect during your exam
A CEM exam is very similar to having a conventional mammogram. However, prior to the exam, a small IV line will be placed, and the dye will be injected into your arm while you are seated. After the injection, you will wait two minutes to allow the contrast agent to flow into your breast. The technologist will then perform the mammogram.
There is no additional compression involved other than what is generally required for a conventional mammogram so the CEM takes the same amount of time.
What are the benefits of CEM?
CEM has been shown to find breast cancers that can’t be seen on regular mammograms, especially in women with dense breasts. It has also been shown to find higher grade forms of cancer than traditional mammography and ultrasound. In this regard, it is similar to MRI of the breast.
What are the risks of CEM?
People who undergo CEM exams are exposed to slightly more radiation than people who have regular mammograms. This additional radiation is about the same as having one extra mammogram picture taken (e.g. five pictures instead of four) or 20% more dose. Rarely, people can have an allergic reaction to intravenous (IV) contrast. Most reactions are mild, such as hives. Some people can have more serious reactions, such as having trouble breathing or facial swelling.
You should tell your doctor if you:
• Have had kidney disease or poor kidney function.
• Have ever had an allergic reaction to iodinated contrast in the past.
• If you are a diabetic on metformin. If you are a diabetic on metformin or a woman over 65 years of age, a blood test to check the kidney function may be necessary.
CEM is not advised for women who are pregnant. During breast feeding a CEM may be performed if necessary after discussion with your doctor.
Will I need to have other imaging or testing with CEM?
Just like with regular mammogram you may need to have additional tests to evaluate your CEM exam findings. These may include an ultrasound, magnetic resonance imaging (MRI) or a biopsy. For more details please see Frequently Asked Questions below.
Before your CEM
If you are older than 65 years of age or have diabetes, you will need to have a blood test called an eGFR (a test for kidney function) before your CEM exam. This test checks to see how your kidneys are working. You will need to have this done within 6 months of your CEM exam.
The day of your CEM exam
Please ensure you drink plenty of fluids on the day of your appointment as this will make it easier for us to find a suitable vein to administer contrast into. The contrast may cause some mild nausea. As with any contrast test in Radiology, we recommend you drink plenty of water before and after the test.
Do not use deodorant, lotion, cream, powder, talc, oils, or perfume before your CEM exam.
Your nurse or radiologist will insert an intravenous line in your arm to administer the IV contrast. After 2 minutes, you will have your CEM exam. You may feel a warm sensation as the IV contrast is inserted. This is normal. Let your nurse or technologist know if you have pain at your IV site or if you feel any unusual symptoms such as itchiness, swelling, dizziness, difficulty breathing, or you feel like you are going to faint.
A CEM exam involves a few more steps than a regular mammogram so the duration of attendance at this appointment will be a little longer. This extra time is needed to check your kidney function (if necessary), insert an IV line, administer the IV contrast and observe you after the test to ensure you remain well.
After your CEM exam
If you are going home after your CEM exam, your nurse will remove your IV and place a bandage over the area. You can remove the bandage after an hour if there is no bleeding.
Drink plenty of water in the 24 hours after your CEM exam to help remove the contrast from your body. For further information please contact
Epworth Medical Imaging
Suite 9, 320 Victoria Parade,
(03) 9418 8293
FREQUENTLY ASKED QUESTIONS
What if there is an abnormal finding on my CEM?
An abnormal finding on CEM may indicate a number of things, ranging from benign breast conditions to breast cancer.
If you receive an abnormal result, rest assured that you are in good hands here at Epworth. You will be referred to a breast specialist (if you are not already seeing one). Your breast specialist will review the results of your CEM, take a thorough medical history, perform a physical examination and with this information, devise a plan to determine the cause the CEM result.
Will I need other tests if my CEM is abnormal?
To determine what the CEM result represents, your specialist may order further imaging tests such as an ultrasound or breast MRI. These further imaging tests will guide whether you require a biopsy or not.
Will I need a biopsy if my CEM is abnormal?
Based on your CEM result +/- further imaging, your specialist will decide whether or not you require a biopsy. The biopsy entails taking a small sample of the area of interest on CEM to determine whether the underlying cells are normal or abnormal. A biopsy can be performed under the guidance of mammography (stereotactic), ultrasound or MRI. The method of biopsy will be determined by the imaging finding, so every case is unique.
What are the different types of breast biopsy available?
An ultrasound guided breast biopsy is the most common method of biopsy and will be performed in the same position that you were scanned at the time of your ultrasound. This will be chosen if the abnormality on CEM is visible on ultrasound.
A stereotactic guided breast biopsy is also very common and will be performed either lying on your side or sitting up in the mammogram machine. This will be chosen if the abnormality on CEM is also visible on the 2D/3D mammogram.
An MRI guided breast biopsy is an increasingly common method of biopsy and is chosen if the abnormality on CEM is not visible on your 2D/3D mammogram or ultrasound. It is performed lying on your chest/stomach in the MRI machine.
Why did my specialist request a breast clip to be inserted at the time of biopsy?
A breast clip is a small piece of metal that serves many useful purposes. It is inserted into the breast at the site of biopsy immediately after the biopsy has been taken, through the same path as the biopsy needle so it does not involve any additional injections. After a clip is inserted, a gentle mammogram will be performed to document its position.
The clip will mark what has been biopsied so your breast specialist can locate it again if they need to. It also serves as a landmark to confirm the structure biopsied matches what was seen on your CEM.