CEM Reliably Identifies Patients for Nipple-Sparing Surgery

Background: Nipple-sparing breast surgery has become increasingly common as a safe option that preserves cosmetic appearance. Determining whether the nipple-areolar complex is infiltrated by tumor is vital for this approach. Traditionally, mammography, ultrasound, and breast MRI have been used to evaluate potential nipple involvement, with MRI the most sensitive. Although contrast-enhanced mammography (CEM) has gained ground for screening and preoperative evaluation due to its ability to highlight enhancing tumor tissue, its usefulness in identifying direct nipple involvement has not previously been systematically evaluated. Given MRI-like ability of CEM to depict enhancement patterns, understanding its accuracy in this specific diagnostic role is clinically important. Objective: To evaluate the accuracy of CEM for ruling in pathologic nipple involvement and assess which CEM features are most associated with true nipple invasion. Design: Retrospective multicenter study. Methods: Inve more...