Diagnostic Performance of Conventional Combined with Contrast‐Enhanced Ultrasonography Versus Dynamic Contrast‐Enhanced Magnetic Resonance Imaging for Preoperative Prediction of Nipple‐Areolar Complex Involvement in Breast Cancer

OBJECTIVES: To compare the diagnostic performance of conventional ultrasonography (US) combined with contrast-enhanced ultrasonography (CEUS) versus dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in preoperatively predicting nipple-areolar complex (NAC) involvement in breast cancer. METHODS: From January 2020 to November 2024, patients with primary breast cancer confirmed by preoperative biopsy were consecutively enrolled in this study. All patients underwent CEUS and DCE-MRI examinations before operation. NAC involvement status was determined by subareolar intraoperative biopsy and postoperative pathology. LASSO regression was used to screen the US and DCE-MRI predictors most related to NAC involvement, and nomograms were constructed accordingly. The data were bootstrapped 500 times for internal verification, and a calibration curve was generated to verify the prediction ability. The area under the receiver operating characteristic curve (AUC) of the 2 models was compared using the DeLong test. RESULTS: We prospectively included 126 primary breast cancer lesions from 124 women in this study: 26 lesions (20.6%) with NAC involvement and 100 lesions (79.4%) without NAC involvement. The AUC of the US-CEUS model for diagnosing NAC involvement was significantly higher than that of the DCE-MRI model (0.893 versus 0.817, p = .047). CONCLUSIONS: US combined with CEUS demonstrated significantly higher diagnostic performance than DCE-MRI in the preoperative prediction of NAC involvement. This supports its role as a valuable complementary tool for identifying candidates for nipple-sparing mastectomy (NSM), particularly in patients with contraindications to gadolinium-based contrast agents or in settings where MRI is unavailable.