Background: Contrast enhanced digital mammography (CEDM) is an advanced breast imaging modality that uses iodinated intravenous contrast to aid in the detection of breast cancer. While previous studies have outlined the benefits of CEDM for the detection of breast parenchymal findings, the assessment of lesions in the skin has yet to be described. Skin lesions can enhance on breast magnetic resonance imaging (MRI) and similarly can take up contrast on CEDM. Both benign and malignant skin lesions are not uncommonly encountered on CEDM and require accurate detection and interpretation. Because the images are acquired with 2D mammography instead of tomosynthesis or multiplanar MRI, determining if a focal lesion is superficial or deep may not be readily apparent. This can lead to unnecessary confusion, additional diagnostic imaging, and potentially recommendation for biopsy.
Learning Objectives: -Understand how CEDM images are acquired, and why that makes the detection of superficial skin findings difficult. -Review the spectrum of skin findings on CEDM, including benign, malignant, and artifact. -Learn how to identify superficial skin enhancement, and next step recommendations for suspicious findings.
Abstract Content/Results: This pictorial essay will review skin findings as seen on CEDM including: skin mole, hemangioma, sebaceous cyst, skin fold, contrast contamination, pustule, post-radiation change, granulomatous mastitis, malignant dermal invasion, and inflammatory breast cancer. The use of mole markers, tangential views, and direct visual inspection to identify superficial skin lesions will be reviewed. For suspicious skin lesions next step considerations include additional imaging with tomosynthesis, MRI and referral for possible punch biopsy or surgical excision.
Conclusion: Following review of this exhibit, the viewer should have a greater familiarity of the spectrum of skin findings on CEDM, tips for identifying their superficial location, and next step recommendations for suspicious findings.
