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Contrast-enhanced mammography versus breast MRI: a multidimensional cost-effectiveness analysis.

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Contrast-enhanced mammography (CEM) shows high diagnostic agreement with dynamic contrast-enhanced MRI (DCE-MRI) for breast cancer staging. Replacing MRI with CEM in concordant cases significantly reduces costs and improves workflow efficiency.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Preoperative staging of breast cancer (BCa) is crucial for treatment planning.
  • Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a standard tool for BCa staging.
  • Contrast-enhanced mammography (CEM) is an emerging alternative imaging modality.

Purpose of the Study:

  • To evaluate the diagnostic concordance between CEM and DCE-MRI in preoperative BCa staging.
  • To assess the clinical, operational, and economic impact of substituting CEM for DCE-MRI in concordant cases.

Main Methods:

  • Retrospective single-center study of 280 patients who underwent both CEM and DCE-MRI.
  • Independent radiologist evaluation of imaging concordance (lesion detection, characterization, interpretability).
  • Cost minimization analysis using regional reimbursement rates and institutional time-motion data.

Main Results:

  • Complete diagnostic concordance was achieved in 67.9% of cases.
  • Substituting CEM for MRI in concordant cases projected a 44.9% cost reduction (€141.20 per patient).
  • Significant savings in scanner time (63+ hours) and radiologist reading time (47+ hours) were observed.

Conclusions:

  • CEM demonstrates substantial diagnostic concordance with DCE-MRI for breast cancer staging.
  • CEM offers significant cost reduction and workflow efficiency benefits.
  • Targeted integration of CEM can support value-based breast imaging without compromising diagnostic quality.