Comparative Analysis of Contrast-Enhanced Mammography and Breast Magnetic Resonance Imaging in Diagnosing and Characterizing Breast Lesions

Abstract

Background: Breast cancer remains the most common malignancy among women worldwide and a major cause of cancer-related mortality.

Objective: This study aimed to compare the diagnostic performance of contrast-enhanced mammography and breast MRI in detecting and characterizing breast lesions, using histopathology as the reference standard.

Methods: A cross-sectional comparative study was conducted at KMU hospital and Research center Peshawar from May 2024 to May 2025. A total of 235 female patients aged 20 years and above with clinically or radiologically detected breast lesions were included. All participants underwent both CEM and breast MRI within a two-week interval, followed by histopathological confirmation through biopsy or surgical excision. 

Results: The mean age of patients was 48.2 ± 10.6 years. Among the 235 lesions, 164 (69.8%) were malignant and 71 (30.2%) were benign. CEM demonstrated a sensitivity of 95.7% and specificity of 85.9%, while MRI showed a sensitivity of 98.8% and specificity of 83.1% (p > 0.05). The overall diagnostic accuracy was 92.8% for CEM and 94.0% for MRI. There was excellent agreement between BI-RADS categories of both modalities (κ = 0.82). MRI detected additional multifocal or multicentric lesions in 6% of patients, while CEM provided better visualization of lesion margins and microcalcifications.

Conclusion: It is concluded that both contrast-enhanced mammography and breast MRI demonstrate high diagnostic accuracy in detecting and characterizing breast lesions. Although MRI remains slightly superior for identifying multifocal disease and assessing lesion extent, CEM offers nearly equivalent diagnostic performance with lower cost, shorter procedure time, and wider availability.