Clinical value of contrast enhanced mammography in breast cancer surveillance: Early detection of disease recurrence in two cases

Contrast-enhanced mammography (CEM) is an emerging functional imaging modality with high sensitivity for breast cancer detection. Its role is expanding in diagnostic problem-solving and high-risk surveillance. We present two cases of occult malignancy detected by CEM in breast cancer survivors with dense breasts and negative conventional imaging. The first, a 68-year-old woman post-mastectomy, had an enhancing lesion on computed tomography (CT) without ultrasound correlation. CEM revealed an 11 mm non-mass enhancement, and a CEM-guided biopsy confirmed intermediate-grade ductal carcinoma in situ (DCIS). The second, a 51-year-old woman post-wide local excision, had unremarkable mammography and ultrasound. Surveillance CEM showed a 15 mm non-mass enhancement, with biopsy confirming high-grade estrogen receptor/progesterone receptor (ER/PR)-positive DCIS with microinvasion. These cases highlight the value of CEM in detecting otherwise occult recurrences. In survivors with dense breasts, especially where magnetic resonance imaging is unavailable, CEM offers a sensitive, cost-effective alternative for early detection and reducing diagnostic delays.