Breast cancer is the most prevalent malignancy among women worldwide, with a total of 6,677 deaths attributed to this disease in 2022, and 36,395 new cases estimated for 2024. Once diagnosed, the most accurate extension study during preoperative staging is vital to decide the most optimal strategy, being also crucial to detect additional ipsilateral or contralateral lesions. Breast MRI is a widely used method for preoperative staging of breast cancer [1, 2].
MRI is a morphofunctional technique based on tumoral neoangiogenesis. Its higher sensitivity allows for the detection of more lesions compared with conventional techniques. 2023 ACR guidelines recommend MRI to evaluate disease extension after breast cancer diagnosis. However, the preoperative staging application of this technique has not been free of controversy during the last years [3, 4, 5].
Authors and international societies differ widely in their opinions on the performance of preoperative breast MRI. Several meta-analyses have indicated that the increased detection of lesions through MRI has increased mastectomy rates without impacting local relapse-free survival, overall survival, or reoperation rates [6, 7, 8, 9].
Breast MRI has limitations like high false positive (FP) rates, long acquisition times, high cost, claustrophobia, and accessibility[10].
Contrast-enhanced mammography (CEM) is becoming the primary alternative to address the challenges associated with breast MRI. CEM uses a dual-energy approach and iodinated contrast material for breast neoangiogenesis assesment. Recombined images showing contrast material uptake can be considered an analog of MRI subtraction images. Meanwhile, low-energy images of CEM are non-inferior to conventional two-dimensional (digital) mammograms [11, 12].
CEM is considered a faster, cheaper, and more accessible technique to implement as a problem-solving in daily screening, with suggested increased sensitivity for breast cancer detection relative to conventional digital imaging [13, 14, 15], and in some cases equal sensitivity with improved specificity relative to breast MRI in the diagnostic setting [16, 17, 18, 19]
This study aimed to retrospectively evaluate the accuracy of CEM and MRI in preoperative staging of breast cancer. A secondary objective was to determine the accuracy of lesion size measurement with both techniques.
