Contrast-enhanced mammography versus breast MRI: a multidimensional cost-effectiveness analysis

Purpose: To assess the diagnostic concordance between contrast-enhanced mammography (CEM) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the preoperative staging of breast cancer (BCa) and to evaluate the clinical, operational, and economic implications of substituting CEM for MRI in concordant cases. Methods: This retrospective single-center study included 280 patients who underwent both CEM and DCE-MRI within 15 days. Two experienced breast radiologists independently evaluated imaging concordance based on lesion detection, characterization, and clinical interpretability. A cost minimization analysis was performed assuming equivalent diagnostic performance in concordant cases. Direct procedural costs were derived from regional reimbursement rates (€215.20 for DCE-MRI; €74.00 for CEM). Operational efficiency was assessed using institutional time-motion data, and average radiologist reporting times were included to model overall organizational impact. Results: Complete diagnostic concordance was observed in 190 cases (67.9%), while 78 (27.9%) showed that clinically relevant discordance and 12 (4.3%) were indeterminate. Substituting CEM for MRI in the concordant group yielded a projected total cost reduction of €26,828, representing a 44.9% decrease and €141.20 saved per patient. Procedural modeling indicated a net scanner time saving of 3,800 min (63 h and 20 min). CEM reporting required 15 min less per case on average, totaling 2,850 min (47 h and 30 min) in cumulative reading time saved. Conclusion: CEM demonstrated substantial diagnostic concordance with MRI in a majority of cases, with significant benefits in cost reduction and workflow efficiency. Targeted CEM integration may support more sustainable, value-based breast imaging without compromising diagnostic quality.