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

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.