Contrast- enhanced digital breast tomosythesis and breast MRI to monitor response to neoadjuvant chemotherapy: patient tolerance and preference

Objective: Contrast-enhanced digital breast tomosyn-thesis (CE- DBT) is a novel imaging technique, combining contrast-enhanced spectral mammography and tomo-synthesis. This may offer an alternative imaging technique to breast MRI for monitoring of response to neoadjuvant chemotherapy. This paper addresses patient experience and preference regarding the two techniques. Methods: Conducted as part of a prospective pilot study; patients were asked to complete questionnaires pertaining to their experience of CE- DBT and MRI following pre-treatment and end - of-treatment imaging. Questionnaires consisted of eight questions answered on a categorical scale, two using a visual analogue scale (VAS), and a question to indicate preference of imaging technique. Statistical analysis was performed with Wilcoxon signed rank test and McNemar test for related samples using SPSS v. 25. Results: 18 patients were enrolled in the pilot study. Matched CE- DBT and MRI questionnaires were completed after 22 patient episodes. Patient preference was indicated after 31 patient episodes. Overall, on 77% of occasions patients preferred CE- DBT with no differ-ence between pre-treatment and end - of-treatment imaging. Overall experience (p = 0.008), non-breast pain (p = 0.046), anxiety measured using VAS (p = 0.003), and feeling of being put at ease by staff (p = 0.023) was better for CE- DBT. However, more breast pain was expe-rienced during CE- DBT when measured on both VAS (p = 0.011) and categorical scale (p = 0.021). Conclusion: Our paper suggests that patients prefer CE- DBT to MRI, adding further evidence in favour of contrast-enhanced mammographic techniques. Advances in knowledge: Contrast mammographic tech-niques offer an alternative, more accessible imaging technique to breast MRI. Whilst other studies have addressed patient experience of contrast-enhanced spectral mammography, this is the first study to directly explore patient preference for CE- DBT over MRI in the setting of neoadjuvant chemotherapy, finding that overall, patients preferred CE- DBT despite the relatively long breast compression.