Contrast-enhanced spectral mammography in the radiological assessment of response to neoadjuvant chemotherapy in breast cancer


  • Anna Grażyńska Students' Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia in Katowice, Poland
  • Sofija Antoniuk Students' Scientific Association, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
  • Katarzyna Steinhof-Radwańska Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, Katowice, Poland



contrast-enhanced spectral mammography, breast cancer, Response Evaluation Criteria in Solid Tumors, neoadjuvant chemotherapy


Accurate morphological assessment and measurement of the residual disease following neoadjuvant chemotherapy are vital for the effective surgical treatment in patients with breast cancer. Neoadjuvant chemotherapy response is measured by RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors), and the classification of the specific therapeutic responses is based on the difference in the tumour size prior to and after chemotherapy. There are currently a few methods of imaging used in the assessment of the neoadjuvant chemotherapy response. Conventional mammography remains the most popular method, whereas magnetic resonance imaging is considered the most effective ones. Nonetheless, the available methods tend to be imperfect and limited, and therefore, new methods are constantly investigated. Contrast-enhanced spectral mammography is a relatively new method used in breast cancer diagnosis, which involves the phenomenon of neoangiogenesis of cancerous tumours, allowing contrast enhancement in the areas of vessel proliferation in the background of the surrounding breast tissue. Contrast-enhanced spectral mammography presents sensitivity similar to magnetic resonance imaging in breast cancer detection, and can be an efficient method used in monitoring neoadjuvant chemotherapy response.


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Wojciechowska U, Didkowska J, Michałek I, Olasek P, Ciuba A. Nowotwory złośliwe w Polsce w 2018 roku. Warszawa: Ministerstwo Zdrowia; 2020.

Fahad Ullah M. Breast Cancer: Current Perspectives on the Disease Status. Adv Exp Med Biol. 2019;1152:51-64. doi: 10.1007/978-3-030-20301-6_4. PMID: 31456179.

King TA, Morrow M. Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy. Nat Rev Clin Oncol. 2015 Jun;12(6):335-43. doi: 10.1038/nrclinonc.2015.63. Epub 2015 Apr 7. PMID: 25850554.

Esposito A, Criscitiello C, Curigliano G. Neoadjuvant Model for Testing Emerging Targeted Therapies in Breast Cancer. J Natl Cancer Inst Monogr. 2015 May;2015(51):51-5. doi: 10.1093/jncimonographs/lgv012. PMID: 26063887.

von Minckwitz G, Untch M, Blohmer JU, Costa SD, Eidtmann H, Fasching PA, Gerber B, Eiermann W, Hilfrich J, Huober J, Jackisch C, Kaufmann M, Konecny GE, Denkert C, Nekljudova V, Mehta K, Loibl S. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012 May 20;30(15):1796-804. doi: 10.1200/JCO.2011.38.8595. Epub 2012 Apr 16. PMID: 22508812.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009 Jan;45(2):228-47. doi: 10.1016/j.ejca.2008.10.026. PMID: 19097774.

Bogaerts J, Ford R, Sargent D, Schwartz LH, Rubinstein L, Lacombe D, Eisenhauer E, Verweij J, Therasse P; RECIST Working Party. Individual patient data analysis to assess modifications to the RECIST criteria. Eur J Cancer. 2009 Jan;45(2):248-60. doi: 10.1016/j.ejca.2008.10.027. Epub 2008 Dec 16. PMID: 19095437.

Croshaw R, Shapiro-Wright H, Svensson E, Erb K, Julian T. Accuracy of clinical examination, digital mammogram, ultrasound, and MRI in determining postneoadjuvant pathologic tumor response in operable breast cancer patients. Ann Surg Oncol. 2011 Oct;18(11):3160-3. doi: 10.1245/s10434-011-1919-5. Epub 2011 Sep 27. PMID: 21947594.

Weiss A, Lee KC, Romero Y, Ward E, Kim Y, Ojeda-Fournier H, Einck J, Blair SL. Calcifications on mammogram do not correlate with tumor size after neoadjuvant chemotherapy. Ann Surg Oncol. 2014 Oct;21(10):3310-6. doi: 10.1245/s10434-014-3914-0. Epub 2014 Jul 24. PMID: 25056851.

An YY, Kim SH, Kang BJ. Residual microcalcifications after neoadjuvant chemotherapy for locally advanced breast cancer: comparison of the accuracies of mammography and MRI in predicting pathological residual tumor. World J Surg Oncol. 2017 Nov 6;15(1):198. doi: 10.1186/s12957-017-1263-8. PMID: 29110671; PMCID: PMC5674773.

Wright FC, Zubovits J, Gardner S, et al. Optimal assessment of residual disease after neo-adjuvant therapy for locally advanced and inflammatory breast cancer--clinical examination, mammography, or magnetic resonance imaging?. J Surg Oncol. 2010;101(7):604-610. doi:10.1002/jso.21559

Fowler AM, Mankoff DA, Joe BN. Imaging Neoadjuvant Therapy Response in Breast Cancer. Radiology. 2017 Nov;285(2):358-375. doi: 10.1148/radiol.2017170180. PMID: 29045232.

Expert Panel on Breast Imaging:, Slanetz PJ, Moy L, Baron P, diFlorio RM, Green ED, Heller SL, Holbrook AI, Lee SJ, Lewin AA, Lourenco AP, Niell B, Stuckey AR, Trikha S, Vincoff NS, Weinstein SP, Yepes MM, Newell MS. ACR Appropriateness Criteria® Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. J Am Coll Radiol. 2017 Nov;14(11S):S462-S475. doi: 10.1016/j.jacr.2017.08.037. PMID: 29101985.

Łuczyńska E, Niemiec J, Hendrick E, Heinze S, Jaszczyński J, Jakubowicz J, Sas-Korczyńska B, Rys J. Degree of Enhancement on Contrast Enhanced Spectral Mammography (CESM) and Lesion Type on Mammography (MG): Comparison Based on Histological Results. Med Sci Monit. 2016 Oct 21;22:3886-3893. doi: 10.12659/msm.900371. PMID: 27768681; PMCID: PMC5077289.

Lobbes MB, Lalji U, Houwers J, Nijssen EC, Nelemans PJ, van Roozendaal L, Smidt ML, Heuts E, Wildberger JE. Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme. Eur Radiol. 2014 Jul;24(7):1668-76. doi: 10.1007/s00330-014-3154-5. Epub 2014 Apr 3. PMID: 24696228.

Steinhof-Radwańska K, Grażyńska A, Barczyk-Gutkowska A, Kajor M, Powązka P, Lorek A, Szlachta-Świątkowska E, Morawska I, Okas K, Lelek Z, Bielińska M, Gisterek I, Casańas B, Pilch-Kowalczyk J. The new method, the old problem - role of contrast-enhanced spectral mammography in the diagnosis of breast cancer among Polish women. Pol J Radiol. 2020 Jul 27;85:e381-e386. doi: 10.5114/pjr.2020.97941. PMID: 32817772; PMCID: PMC7425219.

Łuczyńska E, Niemiec J, Hendrick E, Heinze S, Jaszczyński J, Jakubowicz J, Sas-Korczyńska B, Rys J. Degree of Enhancement on Contrast Enhanced Spectral Mammography (CESM) and Lesion Type on Mammography (MG): Comparison Based on Histological Results. Med Sci Monit. 2016 Oct 21;22:3886-3893. doi: 10.12659/msm.900371. PMID: 27768681; PMCID: PMC5077289.

Patel BK, Hilal T, Covington M, Zhang N, Kosiorek HE, Lobbes M, Northfelt DW, Pockaj BA. Contrast-Enhanced Spectral Mammography is Comparable to MRI in the Assessment of Residual Breast Cancer Following Neoadjuvant Systemic Therapy. Ann Surg Oncol. 2018 May;25(5):1350-1356. doi: 10.1245/s10434-018-6413-x. Epub 2018 Mar 7. PMID: 29516362.

Iotti V, Ravaioli S, Vacondio R, Coriani C, Caffarri S, Sghedoni R, Nitrosi A, Ragazzi M, Gasparini E, Masini C, Bisagni G, Falco G, Ferrari G, Braglia L, Del Prato A, Malavolti I, Ginocchi V, Pattacini P. Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging. Breast Cancer Res. 2017 Sep 11;19(1):106. doi: 10.1186/s13058-017-0899-1. PMID: 28893303; PMCID: PMC5594558.

Barra FR, Sobrinho AB, Barra RR, Magalhães MT, Aguiar LR, de Albuquerque GFL, Costa RP, Farage L, Pratesi R. Contrast-Enhanced Mammography (CEM) for Detecting Residual Disease after Neoadjuvant Chemotherapy: A Comparison with Breast Magnetic Resonance Imaging (MRI). Biomed Res Int. 2018 Nov 8;2018:8531916. doi: 10.1155/2018/8531916. PMID: 30533440; PMCID: PMC6250019.

Patel BK, Gray RJ, Pockaj BA. Potential Cost Savings of Contrast-Enhanced Digital Mammography. AJR Am J Roentgenol. 2017 Jun;208(6):W231-W237. doi: 10.2214/AJR.16.17239. Epub 2017 Apr 5. PMID: 28379734.

Lobbes MB, Lalji UC, Nelemans PJ, Houben I, Smidt ML, Heuts E, de Vries B, Wildberger JE, Beets-Tan RG. The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI. J Cancer. 2015 Jan 5;6(2):144-50. doi: 10.7150/jca.10705. PMID: 25561979; PMCID: PMC4280397.

Carpenter AP, Leemis LM, Papir AS, Phillips DJ, Phillips GS. Managing magnetic resonance imaging machines: support tools for scheduling and planning. Health Care Manag Sci. 2011 Jun;14(2):158-73. doi: 10.1007/s10729-011-9153-z. Epub 2011 Mar 29. PMID: 21533751.

Łuczyńska E, Heinze-Paluchowska S, Hendrick E, Dyczek S, Ryś J, Herman K, Blecharz P, Jakubowicz J. Comparison between breast MRI and contrast-enhanced spectral mammography. Med Sci Monit. 2015 May 12;21:1358-67. doi: 10.12659/MSM.893018. PMID: 25963880; PMCID: PMC4441288.

Kim YS, Chang JM, Moon HG, Lee J, Shin SU, Moon WK. Residual Mammographic Microcalcifications and Enhancing Lesions on MRI After Neoadjuvant Systemic Chemotherapy for Locally Advanced Breast Cancer: Correlation with Histopathologic Residual Tumor Size. Ann Surg Oncol. 2016 Apr;23(4):1135-42. doi: 10.1245/s10434-015-4993-2. Epub 2015 Dec 1. PMID: 26628432.

How to Cite

Grażyńska A, Antoniuk S, Steinhof-Radwańska K. Contrast-enhanced spectral mammography in the radiological assessment of response to neoadjuvant chemotherapy in breast cancer. JMS [Internet]. 2021 Sep. 22 [cited 2023 Jun. 1];90(3):e521. Available from:



Thousand words about...
Received 2021-05-17
Accepted 2021-09-03
Published 2021-09-22