Comparison of Contrast-Enhanced Mammography with MRI for Preoperative Assessment of Breast Cancer: A Pilot Study

This study aimed at evaluating the role of contrast-enhanced mammography (CEM) for detection of multifocal/multicentric disease as compared to MRI in patients with breast carcinoma (BC). The study commenced after obtaining the institute's ethics approval. All included patients underwent CEM and MRI within an interval of 2 weeks. Images were interpreted as per the respective BIRADS lexicon. In addition to the baseline assessment of the index mass and its size, each modality was specifically evaluated for the presence of any additional findings like satellite lesions or non-mass enhancement, which were categorized as multifocal or multicentric disease depending on the location of additional lesions. Histopathology was considered the gold standard to ascertain the malignant nature of additional findings, wherever possible. Majority of the patients in our study had early T stage with clinical T2 (48.6%) followed by T1 stage (25.7%). Additional lesions could be identified in 34 (97.1%) patients on both CEM and MRI. Multifocality of the disease was seen in 23 patients (67.6%) with a median size of 1.2 cm and multicentricity in 11(32.3%) patients with a median size of 1.45 cm on CEM. Multifocality of the disease was seen in 21(61.7%) with a median size of 1.4 cm and multicentricity in 13 patients with a median size of 2 cm on MRI. CEM offers good correlation with MRI for determining the disease extent and multifocal/multicentric disease estimation. It is a new emerging modality and preliminary results showed comparable performance of CEM with MRI. Both the modalities have their inherent advantages and limitations; and longitudinal studies with large sample sizes are needed for further validation and clinical application.