Contrast-Enhanced Mammography for Detection and Characterization of Invasive Lobular Carcinoma

Invasive lobular carcinoma (ILC) poses distinct diagnostic challenges due to its infiltrative single-file growth pattern, which often renders it mammographically occult, particularly in dense breast tissue. Contrast-enhanced mammography (CEM) combines the anatomical detail of conventional mammography with functional information from contrast uptake, likely improving the detection, staging, and assessment of ILC compared to conventional imaging techniques. CEM shows value in evaluating ILC tumor size and disease extent, especially in multifocal and multicentric disease, although MRI remains the gold standard. This review outlines the spectrum of ILC imaging features on CEM, including findings on both low-energy and recombined images. While CEM can provide ILC size and extent estimates comparable to MRI, its accuracy may be reduced in cases of non-mass enhancement or tumors larger than 3 cm. Additionally, ILC may demonstrate lower conspicuity enhancement than invasive ductal carcinoma (IDC), necessitating careful image interpretation. As clinical adoption of CEM increases, radiologists must become familiar with the variable imaging characteristics of ILC, to facilitate more accurate interpretation. Improved recognition of these features has the potential to support more precise treatment planning and better patient outcomes.