Contrast-enhanced mammography sized breast cancers best, but changed few operations

The edition in brief

The PROCEM randomised trial at two Swedish breast centres allocated 415 women with early breast cancer to preoperative contrast-enhanced mammography or standard work-up. Contrast mammography changed treatment in 8.4% (95% CI 5.3–13.1), missing the 10% target, and did not alter mastectomy (17% vs 18%) or reoperation (7.9% vs 10%) rates. It did estimate malignant extent most closely against histology (bias 3.5 mm, against 4.8 mm for mammography or tomosynthesis and 10.7 mm for ultrasound), except in DCIS. An evaluation of the US CMS automated CT quality measure across 254 facilities and 783,634 adult examinations found 30.7% exceeded size-adjusted dose thresholds, while almost none failed on image noise; facility scores ranged from 1.8% to 82.4%, and the worst categories within a single facility were often far apart from its best, so protocols need category-level review. A phase 2 trial of 60 people with multiple myeloma found CD38-targeted zirconium-89 daratumumab immuno-PET detected disease about as often as FDG PET overall, but identified biopsy-confirmed active myeloma missed by FDG in 13%. The pearl is about reporting breast tumour size when modalities disagree.