In patients with invasive breast cancer, additional imaging methods are used in some cases to decide the appropriate surgical therapy. At present, two different imaging methods are used for measuring the extent and for proof or exclusion of multicentricity and multifocality.

Healthcare question

Should contrast-enhanced spectral mammography vs. magnetic resonance imaging be used as additional imaging method in assisting surgical treatment planning in women with histologically confirmed invasive breast cancer?


In women with histologically confirmed invasive breast cancer, the ECIBC's Guidelines Development Group (GDG) suggests using contrast-enhanced spectral mammography (CESM) over magnetic resonance imaging (MRI) as additional imaging method to assist in surgical treatment planning.

Recommendation strength ­

  Conditional recommendation for the intervention

  Low certainty of the accuracy evidence

Subgroup considerations

Women with pacemakers who can’t have an MRI.

Pre-menopausal women should be informed about the feasibility of carrying out the MRI in the post-ovulation phase of their cycle.

Considerations for implementation and policy making

The GDG discussed MRI being currently the test of choice for certain women and settings. Use of CESM will reduce the bottle neck of MRI availability for these patients (would be urgent MRIs given that they have to be done before surgery).

As for any conditional recommendation values and preferences and shared decision making (possibly decision aids) should be taken into account.

Monitoring and evaluation

Overuse of CESM/MRI should be monitored due to a possible increase in referral because of the easiness in conducting the tests.

Research priorities

Better research on accuracy and patient impact. 

Subtypes of breast cancer with CESM especially regarding the likelihood of multicentricity or multifocality.

Supporting documents