Contrast-enhanced mammography in the preoperative assessment of primary operable breast cancer: Results from a prospective, two-centre study.

PURPOSE: To evaluate the performance of contrast-enhanced mammography (CEM) in the preoperative assessment of patients with primary operable breast cancer and in the detection of multifocal or multicentric carcinoma (MFMCC). Secondary aims were to determine the added value of recombined images (CEM-RI) relative to low-energy images (CEM-LEI) in detecting MFMCC.

MATERIALS AND

METHODS

In this prospective multicenter study, 184 patients with newly diagnosed breast cancer were included. All patients underwent CEM, and findings from CEM-LEI and CEM-RI were analysed separately for the detection of MFMCC, using histopathology as the reference standard. The influence of CEM-RI findings on surgical decision-making was evaluated. All patients completed a 12-month clinical and imaging follow-up to assess residual disease and recurrence.

RESULTS

Histopathology confirmed MFMCC in 30/184 patients (16.30%). Sensitivity for MFMCC detection was significantly higher for CEM-RI than for CEM-LEI (86.67% vs. 53.33%, p), while specificity remained high for both techniques (91.56% vs. 90.26%, p). When both image types were assessed together, overall sensitivity increased to 93.33%. CEM-LEI sensitivity decreased with increasing breast density (63.16% for American College of Radiology (ACR) A + B vs. 36.36% for ACR C + D), whereas CEM-RI maintained high sensitivity irrespective of density (78.95% for ACR A+B vs. 100% for ACR C+D). CEM-RI findings led to modification of the planned surgical procedure in 23 of 184 patients (12.43%). The reoperation rate due to R1 resection after breast-conserving therapy was 3.80%.

CONCLUSION

CEM-RI demonstrates significantly greater sensitivity than CEM-LEI for detecting MFMCC and contributes to clinically meaningful changes in surgical management.