Diagnostic Performance of Conventional Combined with Contrast-Enhanced Ultrasonography Versus Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Preoperative Prediction of Nipple-Areolar Complex Involvement in Breast Cancer.

OBJECTIVES

To compare the diagnostic performance of conventional ultrasonography (US) combined with contrast-enhanced ultrasonography (CEUS) versus dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in preoperatively predicting nipple-areolar complex (NAC) involvement in breast cancer.

METHODS

From January 2020 to November 2024, patients with primary breast cancer confirmed by preoperative biopsy were consecutively enrolled in this study. All patients underwent CEUS and DCE-MRI examinations before operation. NAC involvement status was determined by subareolar intraoperative biopsy and postoperative pathology. LASSO regression was used to screen the US and DCE-MRI predictors most related to NAC involvement, and nomograms were constructed accordingly. The data were bootstrapped 500 times for internal verification, and a calibration curve was generated to verify the prediction ability. The area under the receiver operating characteristic curve (AUC) of the 2 models was compared using the DeLong test.

RESULTS

We prospectively included 126 primary breast cancer lesions from 124 women in this study: 26 lesions (20.6%) with NAC involvement and 100 lesions (79.4%) without NAC involvement. The AUC of the US-CEUS model for diagnosing NAC involvement was significantly higher than that of the DCE-MRI model (0.893 versus 0.817, p = .047).

CONCLUSIONS

US combined with CEUS demonstrated significantly higher diagnostic performance than DCE-MRI in the preoperative prediction of NAC involvement. This supports its role as a valuable complementary tool for identifying candidates for nipple-sparing mastectomy (NSM), particularly in patients with contraindications to gadolinium-based contrast agents or in settings where MRI is unavailable.