ARRS 2022 Abstracts

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E1515. Role of CEM in Diagnosis, Staging and Restaging of Inflammatory Breast Cancer Following Neoadjuvant Chemotherapy
Authors
  1. Samantha Snyder; Cooper University Hospital
  2. Paras Patel; Cooper University Hospital
  3. Pauline Germaine; Cooper University Hospital
  4. Robyn Roth; Cooper University Hospital
Background
Inflammatory breast cancer (IBC) is a rare aggressive form of breast cancer, accounting for 1–6% of all breast cancer cases. Though any subtype of invasive breast cancer can account for IBC symptoms, invasive ductal carcinoma is the most prevalent subtype. Mammography is the current standard imaging technique for diagnosing and staging IBC; however, it often fails to detect additional lesions and accurately evaluate the response to neoadjuvant chemotherapy. Currently, contrast-enhanced breast MRI has the highest sensitivity for detecting primary mammary parenchymal lesions and global skin findings seen in IBC and is the main modality in stage and restaging of IBC. Contrast-enhanced mammography (CEM) is an emerging breast imaging technique that combines mammography with the assessment of neovascularity, similar to that of MRI. There are few studies that highlight radiographic findings of IBC on CEM. This exhibit will demonstrate the application of CEM in diagnosis, staging, and restaging of IBC, as well as compare IBC findings on CEM with those on MRI, highlighting another application of CEM in the growing list in clinical practice.

Educational Goals / Teaching Points
This exhibit will illustrate imaging findings of IBC on CEM, highlight the role of CEM in diagnosis, staging, and restaging of IBC in the clinical practice, and compare findings of IBC on CEM and MRI. CEM is a viable alternative to MRI in the setting of IBC in those patients unable to undergo MRI or when MRI is not available.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will review the clinical presentation, imaging findings, and treatment response of IBC on CEM, and compare IBC findings on CEM to those on MRI. There are few studies that highlight radiographic findings of IBC on CEM. We will review currently available literature on CEM, including how CEM is useful in highlighting edematous breasts and assessing tumor response after neoadjuvant chemotherapy. Additionally, we will add to the growing body of literature our experience with two patients. In one patient, we will highlight findings of IBC on CEM in the setting of initial diagnosis and subsequent assessment of response to neoadjuvant chemotherapy. The second patient was initially evaluated with CEM and subsequently underwent MRI for staging purposes, allowing direct comparison of imaging findings of IBC between the two modalities.

Conclusion
In this presentation, we further explore the application of CEM in the setting of IBC, and investigate the role of CEM in detecting and staging IBC and monitoring response to neoadjuvant chemotherapy. Based on our experience and presented information, CEM may serve as a viable alternative to MRI in diagnosis, staging and restaging of IBC, widening the scope of practice for this modality. This is applicable to day-to-day practice by lowering imaging costs, improving practice efficiency, and providing an alternative diagnostic modality to patients with suspected or known IBC who cannot tolerate MRI.