Morphodynamic Features of Contrast-Enhanced Mammography and Their Correlation with Breast Cancer Histopathology

Contrast-enhanced mammography (CEM) combines morphological and functional imaging, enhancing breast cancer (BC) diagnosis. This study investigates the relationship between CEM morphodynamic features and histopathological characteristics of BC. In this prospective study, 50 female patients (mean age: 57.2 ± 13.7 years) with BI-RADS 4-5 lesions underwent CEM followed by surgical excision between December 2022 and May 2024. Low-energy and recombined CEM images were analyzed for breast composition, lesion characteristics, and enhancement patterns, while histopathological evaluation included tumor size, histotype, grade, lymphovascular invasion, and immunophenotype. Spearman rank correlation and multivariable regression analysis were used to evaluate the relationship between CEM findings and histopathological characteristics. Tumor size on CEM strongly correlated with histopathological tumor size (ρ = 0.788, <i>p</i> < 0.001) and was associated with high-grade lesions (<i>p</i> = 0.017). Non-circumscribed margins were linked to a Luminal-B subtype (<i>p</i> = 0.001), while high lesion conspicuity was associated with Luminal-B and triple-negative BC (<i>p</i> = 0.001) and correlated with larger tumors (ρ = 0.517, <i>p</i> < 0.001). Background parenchymal enhancement was negatively correlated with age (ρ = -0.286, <i>p</i> = 0.049). CEM provides critical insights into BC, demonstrating significant relationship between imaging features and histopathological characteristics. These findings highlight CEM's potential as a reliable tool for tumor size estimation, subtype characterization, and prognostic assessment, suggesting its role as an alternative to MRI, particularly for patients with contraindications.