Advancing preoperative staging in early breast cancer: A comparative analysis of imaging modalities.

Background and purpose: Accurate preoperative staging is essential for guiding surgical planning and optimizing outcomes in early-stage breast cancer. Magnetic resonance imaging (MRI) is considered the gold standard but is often limited by cost and availability. This study aimed to prospectively compare the diagnostic performance of full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), and MRI for tumor detection and size estimation in patients eligible for upfront surgery.

Materials and methods: This single-center, prospective study included 46 women with histologically confirmed early-stage invasive breast cancer. All patients underwent FFDM, DBT, CEM, and MRI within one week prior to surgery. Histopathology served as the reference standard. Tumor size measurements were compared using Pearson's correlation coefficients (r), with concordance defined as a size difference within ±10 mm. Detection rates, size accuracy, and ability to identify multifocal lesions were evaluated.

Results: The mean patient age was 55.4 years. FFDM identified the primary tumor in 89.1% of cases, DBT in 97.8%, and both CEM and MRI in 100%. Tumor size correlation with pathology was highest for MRI (r=0.811), followed by CEM (r=0.660), DBT (r=0.636), and FFDM (r=0.314). Concordance with pathology was 80.4% for MRI, 71.7% for CEM and DBT, and 58.7% for FFDM. Multifocal disease was detected in 15.2% of cases by MRI, 8.7% by DBT, and 6.5% by CEM.

Conclusion: CEM and DBT showed strong diagnostic performance and may serve as accessible and cost-effective alternatives to MRI for preoperative staging in early-stage breast cancer. These modalities offer valuable imaging options in settings where MRI is limited or contraindicated.