Redefining Symptomatic Breast Cancer Diagnosis: The Vall d'Hebron Approach with Contrast-Enhanced Mammography
At Vall d'Hebron University Hospital in Barcelona, a premier tertiary care center in Spain, approximately 800 breast cancer cases are diagnosed annually. Within this high-volume symptomatic environment, Dr. Stefania Orlando, Head of Women's Radiology, Vall d'Hebron University Hospital, Barcelona and her team have integrated Contrast-Enhanced Mammography (CEM) to fundamentally alter the diagnostic workflow. This dual-energy technique captures two images simultaneously under a single compression: a low-energy image comparable to conventional digital mammography and a high-energy image for contrast assessment. Sophisticated post-processing combines these into a recombined image that highlights contrast uptake, effectively visualizing tumor neovascularization. This innovation allows clinicians to merge morphological assessment with functional data in a single examination.
Clinical Recognition and Lexicon Updates
The clinical value of this technology has garnered significant international attention. In 2025, the European Association for Quality Screening Imaging acknowledged that the low-energy image in CEM offers superior diagnostic capabilities compared to standard mammography. Consequently, the latest version of the BI-RADS lexicon officially incorporates CEM as a standard modality. This regulatory shift validates CEM as a robust diagnostic imaging tool, enabling its widespread adoption in daily practice.
Optimizing the One-Stop Clinic Model
Dr. Orlando's department utilizes a "one-stop clinic" model where patients are assessed within two hours. In symptomatic settings, CEM often replaces tomosynthesis or whole-breast ultrasound. Instead of performing a comprehensive whole-breast ultrasound to search for targets, the exam is converted into a targeted procedure. This strategy is particularly effective in dense breasts (Type C), where it successfully identifies lesions invisible on conventional imaging. Notable cases include the detection of extensive multifocal invasive lobular carcinoma and the characterization of non-mass enhancement that correlated with extensive lymph node involvement, confirmed by MRI.
Efficiency and Patient-Centered Care
The integration of CEM drives problem-solving capabilities when mammography and ultrasound yield inconclusive results. It facilitates faster decision-making, allowing radiologists to reach confident diagnoses more rapidly. By delivering early functional information at the outset of the diagnostic journey, the department reduces the number of patient visits and associated anxiety. The unit achieves an average turnaround time of just 28 days from referral to treatment initiation. This efficiency supports a personalized approach, providing critical data for both low-risk cases requiring surgery and high-risk cases necessitating adjuvant chemotherapy. Ultimately, CEM addresses patient confusion regarding lesion complexity and improves clinical outcomes by integrating speed, accuracy, and accessibility into the breast cancer diagnosis pathway.
