CEM vs MRI: Enhancing Accuracy in Preoperative Breast Cancer Staging

Accurate preoperative breast cancer staging is essential for determining the most effective surgical approach. Clinicians often rely on magnetic resonance imaging (MRI) as the gold standard for assessing disease extent. However, Contrast-Enhanced Mammography (CEM) has emerged as a rapid and cost-effective alternative. A recent study by Ziada K et al. compared these two modalities to evaluate their performance against postoperative histopathology.

Study Overview and Results

The retrospective analysis included 52 women diagnosed with biopsy-proven breast cancer. These patients underwent both CEM and MRI for staging purposes. Researchers found that CEM successfully detected 51 out of 52 index lesions, achieving a 98% detection rate. In comparison, MRI detected all 100% of the index lesions. The mean size of the index lesions was remarkably similar between the two modalities. Specifically, CEM recorded a mean size of 24.9 mm, while MRI recorded 25.2 mm.

Clinical Impact on Preoperative Breast Cancer Staging

The study demonstrated an intraclass correlation coefficient (ICC) of 0.975, indicating nearly perfect agreement between CEM and MRI for lesion size. Furthermore, the detection of additional suspicious lesions showed a very good agreement with a Kappa value of 0.881. Interestingly, CEM demonstrated a closer agreement with postoperative histopathology regarding total disease extent. The mean bias for CEM was only 0.2 mm, whereas MRI showed a bias of 1.9 mm. Consequently, CEM serves as a highly reliable tool for surgical planning.

The Role of CEM in Modern Oncology

Many centers in India find CEM advantageous due to its lower cost and faster acquisition time compared to MRI. Moreover, CEM is often more tolerable for patients with claustrophobia. Although MRI remains highly sensitive, CEM provides excellent specificity and clarity in measuring tumor size. This accuracy ensures that surgeons can achieve clear margins while preserving healthy tissue whenever possible. Therefore, clinicians should consider CEM a viable alternative for routine staging in breast cancer patients.

Conclusion

Contrast-enhanced mammography offers high concordance with MRI for evaluating tumor size and additional lesions. Because it aligns closely with histopathology, it enhances the reliability of preoperative breast cancer staging. Its efficiency and accessibility make it a promising choice for oncology practices worldwide.

Frequently Asked Questions

Is CEM as effective as MRI for detecting breast cancer lesions?

Yes, research shows that CEM has a 98% detection rate for index lesions, which is highly comparable to the 100% sensitivity reported for MRI in recent studies.

How does CEM assist in preoperative breast cancer staging?

CEM accurately measures the size of the primary tumor and identifies additional suspicious lesions, providing a clear map for surgical planning that closely matches pathological findings.

What are the main advantages of CEM over MRI?

CEM is generally faster, more cost-effective, and better tolerated by patients. It also demonstrates a slightly closer agreement with histopathology for total disease extent in some clinical settings.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Refer to the latest local and national guidelines for clinical practice.

References

1. Ziada K et al. Comparison of preoperative breast cancer disease extent on contrast-enhanced mammography (CEM) versus magnetic resonance imaging (MRI). Clin Radiol. 2026 May 12. doi: undefined. PMID: 42119266.

2. Douek M et al. Comparison of contrast-enhanced mammography and breast MRI in tumour extent assessment: A systematic review and meta-analysis. Eur J Surg Oncol. 2026 Mar 15. doi: 10.1016/j.ejso.2026.111410.

3. Gilbert FJ et al. Abbreviated MRI and Contrast-Enhanced Mammography Provide Fourfold Higher Cancer Detection than Breast Ultrasound. The Lancet. 2025 May 22.