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Cancer Screening, Diagnosis and Care

European guidelines on breast cancer screening and diagnosis


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10. Planning surgical treatment

Contrast-enhanced mammography

Issued on: October 2021

Healthcare question

Should contrast-enhanced mammography vs. magnetic resonance imaging be used as additional imaging method to assist in surgical treatment planning in women with histologically confirmed invasive breast cancer?

Recommendation

In women with histologically confirmed invasive breast cancer, who require further evaluation, the ECIBC's Guidelines Development Group (GDG) suggests using contrast-enhanced mammography (CEM) over magnetic resonance imaging (MRI) as additional imaging method to assist in surgical treatment planning.

Recommendation strength

Conditional recommendation
Low certainty of the test accuracy evidence

Justification

The decision on this recommendation takes into account the balance between desirable and undesirable effects that was judged as not favouring either CEM or MRI in the context of low certainty of the evidence. The GDG considered that costs, acceptability and feasibility are probably in favour of CEM.

Subgroup considerations

Women with medical devices that are not compatible with MRI can have a CEM.

Considerations for implementation and policy making

The GDG discussed that MRI is currently the test of choice for certain women and settings. The use of CEM will reduce the bottle neck of MRI availability for these patients (it would be urgent MRIs given that they have to be done before surgery).

As for any conditional recommendation, values and preferences and shared decision making (possibly decision aids) should be taken into account. For more information, refer to What the strength of the recommendation implies

Research priorities

  • Additional, credible research on accuracy and patient impact.
  • Subtypes of breast cancer with CESM especially regarding the likelihood of multicentricity or multifocality.
  • Identification of subgroups of women who might benefit from this examination.

Supporting material

yes