Contrast-enhanced mammography (CEM) combines morphological and functional imaging, enhancing breast cancer (BC) diagnosis. This study investigates the relationship between CEM morphodynamic features and histopathological characteristics of BC. In this prospective study, 50 female patients (mean age: 57.2 ± 13.7 years) with BI-RADS 4–5 lesions underwent CEM followed by surgical excision between December 2022 and May 2024. Low-energy and recombined CEM images were analyzed for breast composition, lesion characteristics, and enhancement patterns, while histopathological evaluation included tumor size, histotype, grade, lymphovascular invasion, and immunophenotype. Spearman rank correlation and multivariable regression analysis were used to evaluate the relationship between CEM findings and histopathological characteristics. Tumor size on CEM strongly correlated with histopathological tumor size (ρ = 0.788, p < 0.001) and was associated with high-grade lesions (p = 0.017). Non-circumscribed margins were linked to a Luminal-B subtype (p = 0.001), while high lesion conspicuity was associated with Luminal-B and triple-negative BC (p = 0.001) and correlated with larger tumors (ρ = 0.517, p < 0.001). Background parenchymal enhancement was negatively correlated with age (ρ = −0.286, p = 0.049). CEM provides critical insights into BC, demonstrating significant relationship between imaging features and histopathological characteristics. These findings highlight CEM’s potential as a reliable tool for tumor size estimation, subtype characterization, and prognostic assessment, suggesting its role as an alternative to MRI, particularly for patients with contraindications.

Background/Objectives : Contrast-enhanced mammography (CEM) integrates morphological and functional imaging using contrast agents, making it a valuable tool in breast cancer (BC) diagnosis. In 2022, the Breast Imaging Reporting and Data System for CEM was introduced. This study aims to investigate the relationship between CEM morphodynamic features and the histopathological characteristics of BC. Methods: In this prospective study were consecutively enrolled, between December 2022 and May 2024, patients with BI-RADS 4 or 5 lesions undergoing CEM followed by surgical excision. Low-energy and recombined CEM images were analysed for breast composition, lesion characteristics, and enhancement patterns. Histopathological evaluation included tumor size, histotype, grade, lymphovascular invasion and immunophenotype. Spearman rank correlation and multivariable regression analysis were used to evaluate the relationship between CEM findings and histopathological characteristics. Results: Fifty female patients (mean age: 57.2 ± 13.7 years) and 50 BCs were analysed. Tumor dimensions observed on CEM showed a strong correlation with histopathological tumor size (ρ = 0.788, p < 0.001) and were associated with grade 3 lesions (p = 0.017). Not circumscribed margins on CEM were significantly associated with the Luminal-B (p = 0.001), while high lesion conspicuity was associated with Luminal-B and triple-negative (p = 0.001) and correlated with larger tumor size (ρ = 0.517, p < 0.001). Background parenchymal enhancement negatively correlated with patient age (ρ = -0.286, p = 0.049). Conclusions : CEM provides critical insights into BC morphology and biology, demonstrating significant relationship between imaging features and histopathological characteristics.

Women with a personal history of breast cancer (PHBC) are at increased risk of local recurrence or new primary tumors, which are often difficult to assess on conventional imaging because of postoperative changes. This prospective study aimed to evaluate the diagnostic performance of contrast-enhanced mammography (CEM) in women with PHBC presenting with suspicious findings on follow-up mammography or ultrasound. Sixty-two patients underwent CEM between December 2023 and June 2025. Lesions showing enhancement were biopsied, while non-enhancing ones were followed for stability. Histopathology served as the reference standard. Diagnostic performance was assessed using standard statistical methods, including sensitivity, specificity, Fisher’s exact test, and ROC analysis. Among 62 lesions, 34 were enhanced on CEM; 30 of these (88.2%) were malignant, whereas 25 of 28 non-enhancing lesions (89.3%) were benign (p < 0.001). CEM demonstrated a sensitivity of 90.9%, specificity of 86.2%, and diagnostic accuracy of 88.7%. Interobserver agreement was substantial (κ = 0.76, p < 0.001). Enhancement on recombined CEM images was strongly associated with malignancy. These findings confirm that CEM provides excellent diagnostic performance in the surveillance of women with PHBC, effectively distinguishing benign from malignant postoperative changes. CEM may serve as a practical and accessible alternative to magnetic resonance imaging, particularly in patients with contraindications or where it is unavailable.