Background: Diffusion-weighted imaging and elastography are widely accepted methods in the evaluation of breast masses, however, there is very limited data comparing the two methods. The apparent diffusion coefficient is a measure of the diffusion of water molecules obtained by diffusion-weighted imaging as a part of breast MRI. Breast elastography is an adjunct to conventional ultrasonography, which provides a noninvasive evaluation of the stiffness of the lesion. Theoretically, increased tissue density and stiffness are related to each other. The purpose of this study is to compare MRI ADC values of the breast masses with quantitative elastography based on ultrasound shear wave measurements and to investigate their possible relation with the prognostic factors and molecular subtypes. Methods: We retrospectively evaluated histopathologically proven 147 breast lesions. The molecular classification of malignant lesions was made according to the prognostic factors. Shear wave elastography was measured in kiloPascal (kPa) units which is a quantitative measure of tissue stiffness. DWI was obtained using a 1.5-T MRI system. Results: ADC values were strongly inversely correlated with elasticity (r = −0.662, p < 0.01) according to Pearson Correlation. In our study, the cut-off value of ADC was 1.00 × 10⁻³ cm²/s to achieve a sensitivity of 84.6% and specificity of 75.4%, and the cut-off value of elasticity was 105.5 kPa to achieve the sensitivity of 96.3% and specificity 76.9% to discriminate between the malignant and benign breast lesions. The status of prognostic factors was not correlated with the ADC values and elasticity. Conclusions: Elasticity and ADC values are correlated. Both cannot predict the status of prognostic factors and differentiate between molecular subtypes.

Background: Phyllodes tumors of breast are rare fibroepithelial neoplasms. They have similar radiological findings with fibroadenomas. While fibroadenomas are benign lesions, phyllodes tumors may have malignant potential. Therefore, any imaging findings to differentiate fibroadenoma from phyllodes tumor are valuable. Case presentation: A 51-year-old female patient was admitted to our clinic with the complaint of a palpable mass. Tru-Cut biopsy resulted as phyllodes tumor, and excision was recommended. However, the patient neglected herself during the COVID-19 pandemic, and 20 months later, she presented with a huge and complex mass. On CESM imaging, cystic areas and clefts were identified. The case was diagnosed as borderline phyllodes tumor. Conclusions: Although MRI findings of phyllodes tumor are well known and reported many times, there is no information about CESM findings of this tumor in literature. Bubbly appearance on CESM is useful finding in the diagnosis of phyllodes tumor of breast.

Objective: To compare contrast-enhanced mammography (CEM) with breast magnetic resonance imaging (MRI) in evaluating residual tumor size and pathological complete response after neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods: This prospective study included patients with histopathologically confirmed breast cancer who were scheduled to receive NAC followed by surgery. All patients underwent both CEM and breast MRI before initiation of NAC and within seven days after completion of treatment. Surgery was performed at a median of 14 days after post-treatment imaging. Residual tumor size measurements obtained by both imaging modalities were compared with histopathological findings, which served as the reference standard. Pathological complete response was defined as the absence of residual invasive carcinoma in the surgical specimen. Results: A total of 74 female patients were included. CEM estimated residual tumor size within ±1 cm of histopathology in 84.7% of cases, whereas MRI achieved this accuracy in 76.4%. Agreement with histopathology was higher for CEM than for MRI. In predicting pathological complete response, CEM demonstrated higher sensitivity (91.3%) and negative predictive value compared with MRI; however, this difference did not reach statistical significance (p = 0.24). MRI showed slightly higher specificity. Pathological complete response was observed in 31.1% of patients. Conclusion: Contrast-enhanced mammography demonstrated performance comparable to breast MRI in assessing response to neoadjuvant chemotherapy, with numerically higher sensitivity for predicting pathological complete response. CEM may represent a practical and accessible alternative to MRI, particularly in settings where MRI is unavailable or contraindicated. These findings support the clinical use of CEM as a reliable alternative imaging modality for response assessment.