The Role of Contrast-Enhanced Mammography in the Pre-Operative Assessment of Breast Cancer

REHAB EL BADRY, M.D.3; REHAB EL SHEIKH, M.D.4;, SHERIHAN W.Y. GAREER, M.D.1; NADA E. ABBASS, M.Sc.2; ABEER A. EL SHARAWY, M.D.3;; ABDULLAH H. AHMED, M.D.6, TAREK M. ABDEL-HAMID, M.D.5 And

doi:10.21608/mjcu.2025.444928

The Role of Contrast-Enhanced Mammography in the Pre-Operative Assessment of Breast Cancer

Document Type : Original Article

Authors

SHERIHAN W.Y. GAREER, M.D.1; NADA E. ABBASS, M.Sc.2; ABEER A. EL SHARAWY, M.D.3; REHAB EL BADRY, M.D.3; REHAB EL SHEIKH, M.D.4;
TAREK M. ABDEL-HAMID, M.D.5 and ABDULLAH H. AHMED, M.D.6

The Department of Radiodiagnosis, National Cancer Institute, Cairo University1, Radiodiagnosisat Department, Om-Elmasreen General Hospital2, Department of Radiodiagnosis at NCI3, Radiology Department, Faculty of Medicine, MUST University4, Department of Radiodiagnosis Department, Faculty of Medicine (for Boys), Al-Azhar University5 and Radiodiagnosis Department, Faculty of Medicine (for Girls), Al-Azhar University6

10.21608/mjcu.2025.444928

Abstract

Background: Accurate staging of breast cancer is vital in establishing a correct treatment plan. Contrast enhanced Spec-tral mammography (CESM), an established technique that can provide more information regarding the number and size of le-sions, can help in deciding the surgical outcome. Aim of Study: Examine the effectiveness of (CESM) in identifying multiple breast cancer lesion, whether multifocal or multicentric and assessing tumor size prior to treatment planning. Patients and Methods: Prospective study done in both the National Cancer Institute and Al-Azahraa University from 2021 to 2024 involving 200 female patientswith solid breast masses classified as BI-RADS IV or V using conventional mammogra-phy and ultrasound. All patients underwent standard 2D mam-mography and CESM, with results compared to post-operative pathology reports which served as the gold standard. Results: CESM demonstrated a higher accuracy than dig-ital mammography in detecting other lesions with a respective value of 96.5% and 72.5%. it demonstrated. • Multiplicity Detection: CESM identified multifocal lesions in 86 patients and multicentric lesions in 97, while pathology confirmed multifocal lesions in 87 and multicentric lesions in 93. CEM demonstrated higher accuracy (96.5%) compared to digital mammography (72.5%). • Tumor Size Assessment: CESM showed 63% concordance with pathology, while digital mammography had only 34% concordance. CEM tended to slightly overestimate tumor size, whereas digital mammography often underestimated it. • T Staging: CESM accurately staged 94% of cases, compared to 84% with digital mammography. Conclusion: CESM significantly improves the detection of lesion multiplicity and provides more accurate tumor size measurements, making it a valuable tool for pre-operative eval-uation and treatment planning in breast cancer.

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