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So, let's talk about contrast

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enhanced mammo compared to MRI.

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Well, there is— the studies have shown a similar

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accuracy of contrast mammo to MR. What this means,

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really, it's a measure of how well

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contrast mammo accuracy is a measure of how well it

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finds cancer and how well it doesn't find non-cancer.

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So let's look at that.

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Sensitivity is, um, ability to find cancer.

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And these are two meta-analyses, uh, performed in 2020

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and 2022 with a different number of included studies.

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And they found that, um, the first study found that the

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sensitivity for contrast mammo and MRI was the same—

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97%, and the second one, more recent one, found

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that there was a difference in sensitivity.

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Contrast enhanced mammo had a sensitivity of 91%.

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MRI had a sensitivity of 97%, um, which was a

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little bit different and actually not unexpected,

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given that MRI is, um, a cross-sectional imaging

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exam. We're getting much more information than we can

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on contrast enhanced mammo, which is a 2D, uh, planar exam.

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But when we look at the specificity, we see

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that the specificity, um, is actually higher

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for contrast enhanced mammo as compared to MRI.

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And this again, really the take-home message that I

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would say a majority of us leave when looking at all

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of the individual studies and at these meta-analyses,

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is that MRI does do a little bit of a better job at finding

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individual breast cancers, and by really a few extra,

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um, but it has a much—contrast enhanced mammo has a

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much better specificity so that overall the diagnostic

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accuracy of these two exams is fairly comparable.

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We'll get into, um, the specific clinical, uh, how we're

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using it in clinical practice and how the data compares.

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Let's look at an example of a contrast

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enhanced mammogram compared to MRI.

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So this is a low energy image from a contrast mammo.

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We see a mass.

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These are the recombined images where we see a mass,

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but we can also see enhancement extending towards the nipple.

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And so let me show you, this is the MRI

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exam, which shows the exact same findings.

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And I would say for people that are new to contrast mammo,

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whenever you look at the recombined images often enough,

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if you were to then perform an MRI,

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the images are almost identical.

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Identical is maybe a strong— they're very similar.

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And so how you would describe the imaging

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finding on the recombined images is similar

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to how you would describe it on an MRI.

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Contrast enhanced mammography is

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also more affordable, uh, than MRI.

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We bill it as a diagnostic mammogram plus contrast.

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There's no

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formal code for it yet. It's also more accessible.

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As I mentioned, it's just an add-on to

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a mammography unit that can be upgraded.

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We— it allows for real-time

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interpretation, as I also mentioned.

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Um, and so often enough, MRI is read offline.

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We read them when the patients are not here. For

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contrast enhanced mammography, we can read them

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while the patient is sitting in our department.

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The number of times that I've done these exams

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and have shown the patients the images,

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have shown them when they're totally negative.

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In a patient who has dense breast tissue—it's

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really comforting to these women to know,

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no, no, they can believe these results.

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Or similarly, in a patient where the contrast mammo

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is done for staging, I can say, no, no, don't worry.

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This—this area is isolated to this one small thing.

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You're good.

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The rest of your breasts are just fine.

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So, um, this imaging modality allows us to

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maintain that communication with our patients,

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um, especially in this time where I think that

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that communication and connection is important.

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Patients also prefer contrast enhanced mammo.

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This was a study that we recently published.

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These are women who have a history of breast

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cancer, and we asked them, if both MRI and

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contrast mammo have an equal chance of finding

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your breast cancer, which would you prefer?

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And you can see that far majority, 73%—hopefully, like

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my annotations—um, actually would prefer CEM. Only 10%

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um, preferred MRI.

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Another nice thing is that we

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don't have to do an MRI biopsy.

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So for anybody considering CEM, I would

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highly recommend that you get CEM biopsy.

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Um, I have not done it myself,

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but I've seen them, and they are awesome.

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Um, CEM biopsy is just like a stereo biopsy.

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The patient experience is very similar and at least—

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what I have perceived—is so much better than what

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women are going through for these MRI biopsies.

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So it allows us

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to divert patients from MRI biopsy to CEM

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biopsy, and that's, I think, an absolute

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game-changer for this imaging modality.