Additional malignant lesions not detected by CEM
False-negative lesions are known to occur with both CEM and MRI but in this study were more common with CEM. However, it is important to note that in any lesion-level analysis, sensitivity is subject to extreme verification bias as only those lesions detected on imaging are assessed by the reference standard [The five cases where MRI detected an additional malignant lesion not identified on CEM are shown in Figs. Notably, this study was performed early in our experience with CEM and minimally enhancing lesions may have been dismissed as background enhancement. There is evidence for a learning curve for CEM interpretation [In addition to the degree to which it enhances, the conspicuity of a lesion may be influenced by the level of surrounding BPE. Neither the CEM or MRI studies in our patients were timed according to the menstrual cycle, nor is this done in clinical practice to avoid delays in treatment. Studies to date have not found significant variation in CEM BPE with the menstrual cycle [