Contrast-enhanced mammography for tumor size assessment and detection of multifocal and multicentric disease in breast cancer subtypes

The role of Contrast-Enhanced Mammography (CEM) in preoperative staging of breast cancer with different histological types and molecular subtypes is investigated by assessing the size of the primary tumor and distinguishing multifocal and/or multicentric breast cancer (MMBC). Data were continuously collected from patients who underwent CEM imaging due to suspected breast lesions from July 2019 to July 2024. The correlation between CEM measurements and histopathological size measurements was analyzed by using Pearson correlation coefficients. Bland-Altman plots were constructed to compare the agreement between tumor size measured by CEM and tissue pathology size measurements from surgical specimens. The presence of multifocal and/or multicentric disease is also evaluated. The correlation between CEM-measured maximum tumor size and pathological measurements is poorer for non-special type/invasive ductal carcinoma compared to other histological types, with HER2 and triple-negative molecular subtypes showing better correlation than luminal A and luminal B subtypes. The frequency of MMBC identified solely by CEM did not show statistically significant differences across histological types or molecular subtypes. This retrospective study indicates that histological type and molecular subtype may influence the assessment of tumor size in breast cancer using CEM.