Comparison of Contrast-Enhanced Mammography and Breast MRI for NAC Assessment

Overview

This study compared contrast-enhanced mammography (CEM) and breast MRI for preoperative evaluation of nipple-areola complex (NAC) involvement in breast cancer patients. Both imaging modalities demonstrated diagnostic utility, with MRI showing higher sensitivity and CEM offering advantages in accessibility and patient tolerability, especially in older patients.

Background

Accurate assessment of NAC involvement is critical for surgical planning in breast cancer, as NAC infiltration contraindicates nipple-sparing procedures. MRI is considered the gold standard for locoregional staging due to its high sensitivity and specificity. Contrast-enhanced mammography is emerging as a reliable alternative, potentially offering faster, more accessible imaging suitable for patients contraindicated for MRI. However, limited data exist comparing CEM and MRI specifically for NAC evaluation.

Data Highlights

Key Findings

• MRI demonstrated pooled sensitivity and specificity of 71% and 94% respectively for NAC involvement assessment.
• CEM showed promising diagnostic performance comparable to MRI in detecting NAC infiltration.
• Institutional policy allocated CEM primarily to women aged ≥60 or those with MRI contraindications, reflecting real-world clinical practice.
• Histopathological confirmation of NAC involvement included invasive carcinoma, DCIS, or Paget’s disease cells within nipple tissue.
• Both imaging modalities were interpreted independently by experienced radiologists blinded to clinical and histopathological data except tumor location.
• CEM offers advantages in accessibility, speed, and patient tolerability, especially for older patients or those unsuitable for MRI.

Clinical Implications

CEM represents a viable alternative to MRI for preoperative NAC assessment, particularly in older patients or those with contraindications to MRI. Its comparable diagnostic accuracy supports its integration into clinical workflows to optimize surgical planning and patient comfort. MRI remains the preferred modality for younger patients and those requiring comprehensive locoregional staging.

Conclusion

Contrast-enhanced mammography provides diagnostic performance comparable to breast MRI for preoperative NAC evaluation in breast cancer, supporting its use as an accessible and well-tolerated imaging option in appropriate patient populations.

References

1. European Society of Breast Cancer Specialists (EUSOMA) 2022 -- Criteria for Preoperative Imaging
2. Meta-analysis 2023 -- MRI Sensitivity and Specificity for NAC Involvement
3. Institutional Study 2022 -- Real-World Comparison of CEM and MRI