Study limitations
malignancy, multifocal/multicentric disease
MALIGNANCIES, PATHOLOGY, OCCULT CANCER
Our study had some limitations. First, our initial power calculation was based on the ability of CEM and MRI to detect any additional lesion, regardless of the underlying pathology. The small number of additional otherwise occult cancers in our sample has resulted in wide confidence intervals for sensitivity and positive predictive values, which limits the strength of our conclusions, particularly in regard to the apparent higher sensitivity of MRI for additional malignancies in comparison to CEM. Second, the readers’ very limited experience with CEM could have (at least in part) been responsible for some of the CEM false negatives. Third, in any lesion-level analysis in which a lesion needs to be identified before it can be assessed, verification bias is unavoidable. As in previous studies, not all patients had bilateral mastectomies and standard tissue processing rather than large format techniques [Despite these limitations, our results do raise doubt that CEM may not be as sensitive as MRI for detection of multifocal/multicentric disease. As noted in a recent systematic review and meta-analysis [In conclusion, while the practical advantages of CEM make it a very attractive tool, our findings suggest that CEM may not be as sensitive as MRI in the preoperative setting for detecting otherwise unsuspected additional foci of malignancy that could impact the surgical treatment and final patient outcomes.