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Exclusion criteria were symptoms, implants, allergy to contrast agents, renal failure, and pregnancy. SA and CEM were independently evaluated by one of six radiologists, who recommended biopsy or 2-year follow-up. Biopsy rates according to SA or recombined CEM (rCEM) were compared with the McNemar\u2019s test. Diagnostic performance was calculated considering lesions with available final histopathology.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Between January 2019 and July 2021, 220 women were enrolled, 207 of them (median age 56.6 years) with 225 suspicious findings analysed. Three of 207 patients (1.4%) developed mild self-limiting adverse reactions to iodinated contrast agent. Overall, 135\/225 findings were referred for biopsy, 90\/225 by both SA and rCEM, 41\/225 by SA alone and 4\/225 by rCEM alone (2\/4 being one DCIS and one invasive carcinoma). The rCEM biopsy rate (94\/225, 41.8%, 95% CI 35.5\u201348.3%) was 16.4% lower (<jats:italic>p<\/jats:italic> &lt; 0.001) than the SA biopsy rate (131\/225, 58.2%, 95% CI 51.7\u201364.5%). Considering the 124\/135 biopsies with final histopathology (44 benign, 80 malignant), rCEM showed a\u00a093.8% sensitivity (95% CI 86.2\u201397.3%) and a\u00a065.9% specificity (95% CI 51.1\u201378.1%), all 5 false negatives being ductal carcinoma in situ detectable as suspicious calcifications on low-energy images.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Compared to SA, the rCEM-based work-up would have avoided biopsy for 37\/225 (16.4%) suspicious findings. Including low-energy images in interpretation provided optimal overall CEM sensitivity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p>\u2022 <jats:italic>The work-up of suspicious findings detected at mammographic breast cancer screening still leads to a high rate of unnecessary biopsies, involving between 2 and 6% of screened women.<\/jats:italic><\/jats:p>\n                <jats:p>\u2022 <jats:italic>In 207 recalled women with 225 suspicious findings, recombined images of contrast-enhanced mammography (CEM) showed a 93.8% sensitivity and a 65.9% specificity, all 5 false negatives being ductal carcinoma in situ detectable on low-energy images as suspicious calcifications.<\/jats:italic><\/jats:p>\n                <jats:p>\u2022 <jats:italic>CEM could represent an easily available one-stop shop option for the morphofunctional assessment of screening recalls, potentially reducing the biopsy rate by 16.4%.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-022-08868-3","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T06:02:22Z","timestamp":1654063342000},"page":"7388-7399","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Contrast-enhanced mammography for the assessment of screening recalls: a two-centre study"],"prefix":"10.1007","volume":"32","author":[{"given":"Andrea","family":"Cozzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Schiaffino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Fanizza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Magni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Menicagli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian Giuseppe","family":"Monaco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienn","family":"Benedek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Spinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Di Leo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Di Giulio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6545-9427","authenticated-orcid":false,"given":"Francesco","family":"Sardanelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,6,1]]},"reference":[{"key":"8868_CR1","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1038\/bjc.2013.177","volume":"108","author":"MG Marmot","year":"2013","unstructured":"Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M (2013) The benefits and harms of breast cancer screening: an independent review. 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None of them has relationships with any companies, whose products or services may be related to the subject matter of the article.Simone Schiaffino received travel support from Bracco Imaging and is a member of the speakers\u2019 bureau for GE Healthcare.Francesco Sardanelli received research grants from \u2014 and is a member of the speakers\u2019 bureau of \u2014 GE Healthcare, Bayer, and Bracco; he is also a member of the Bracco Advisory Group.All other authors declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Andrea Cozzi and Giovanni Di Leo have significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all patients in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"This study was approved by the Ethics Committee of IRCCS Ospedale San Raffaele, Milano, Italy (protocol code CESM; approved on May 10, 2018), and by the Ethics Committee of Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (protocol code P-20190076950, approved on September 25, 2019).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"One-hundred twenty patients included in this study were previously reported in another article (doi: 10.3390\/cancers14071774) that is however solely focused on the analysis of the radiation dose of CEM and does not involve any kind of consideration or analysis related to the topic of the present study.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 Prospective\u2022 Diagnostic\u2022 Multicentre","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}