Morpho-Dynamic Features of Contrast-Enhanced Mammography and Their Correlation with Breast Cancer Histopathology

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.