Contrast-Enhanced Mammography in Breast Lesion Assessment: Accuracy and Surgical Impact

Objective: To compare the accuracy of Contrast-Enhanced Mammography (CEM), Mammography (MG), and Breast Ultrasound (US) in estimating the size of breast lesions requiring surgical intervention. The post-operative histological size of the lesion was used as the gold standard. Additionally, the impact of Additional Lesions (AL) on surgical planning (mastectomy vs. conservative surgery) was evaluated. Materials and Methods: The analysis included 267 non-benign lesions in 205 patients. All selected patients underwent both conventional imaging examinations (US and MG) and CEM. Subsequently, all patients were scheduled for surgery following a biopsy exam-ination. The maximum lesion diameter on imaging was measured by two experienced radiologists and then compared with the lesion size in the histological specimen obtained in the outpatient clinic. Results: Among the 267 breast lesions, 196 were evaluated using US, 196 with MG, and 267 with CEM. No statistically significant differences were found between lesion meas-urements obtained with CEM and those from the surgical specimen (p-value 0.07), whereas a significant difference was observed for MG and US (p < 0.001). In 28 out of 205 patients, 35 ALs were diagnosed. In 15 patients, the presence of ALs did not alter surgical planning; in the remaining 13 patients, 6 had one or more contralateral ALs, and in the other 7 patients, the ALs were in the ipsilateral breast. The impact of ALs on surgical outcomes was assessed. Conclusion: CEM is a reliable method for estimating breast lesion size, and the detection of ALs does not increase the number of mastectomies but rather aids in defining the appropriate surgical approach.