الفهرس 
Introduction and Aim of WorkOnly 14 pages are availabe for public view
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Abstract
Breast cancer in women is a major public health problem throughout the world, being the second most common cancer worldwide; 627 000 deaths in 2018. In Egypt 2014, breast cancer has hit the highest incidence among all cancers in women, accounting for 21.6 % of cancer related mortality rate, according to the WHO.
Sonomammography has been always recommended as the basic breast imaging modality for early detection and diagnosis of breast cancer. Though advances have been introduced to mammography, some malignant tumors have been missed, specially in dense breasts. Also, high false-negative rate have been reported, which could be attributed to existing technological limitations or human error.
Contrast enhanced spectral mammography is a new modality, used to depict the tumor vascularity and neo-angiogenesis, neo-angiogenesis is recognized as a classic sign of malignant tumors.
Our present study using dual energy contrast enhanced mammography technique confirms the potential role for adding contrast enhanced dual energy mammography to improve the diagnosis of breast cancer.
Sensitivity was higher for MX+CEDM (100 %) than that was for sonomammography alone (36.8%) compared to pathology analysis with no significant loss in specificity.
The diagnostic accuracy of CEDM+ MX for the detection of breast carcinoma, has proven to be superior to sonomammography alone. Role of DECM was superior in about 36.1 % of cases, and no difference with adding DECM to conventional sonomammography in 63.9 % of cases.
Also accuracy of diagnosis by adding CEDM increased to about 94.4 % versus only 63.89 % using the conventional sonomammography.
CEDM had a better diagnostic accuracy mainly due to improved positive and negative predictive values (Positive predictive value about 90.48, negative predictive value 100 ).
So, our study appreciates the potential role of CEDM in detection of multifocal / multicentric carcinomas with particular interest for the assessment of the extent of disease specially in dense breasts where the sensitivity of mammography is lower.
Other studies showed that CESM was found to have similar sensitivity for breast cancer detection as breast MRI, having higher PPV and less background enhancement. CESM has the advantage of significantly shorter exam time thus a more accessible alternative to MRI, and has the potential to be an important tool in breast cancer detection and staging.