The combined application of tomosynthesis and contrast-enhanced digital mammogram enhanced the performance of the traditional DM and presented an informative method in the staging of breast cancer. Advances in knowledge: Staging and management planning of breast cancer can divert according to tumour size, multiplicity and the presence of microcalcifications. DBT shows sharp outlines of the tumour with no overlap tissue and spots microcalcifications. Contrast-enhanced spectral mammogram shows the extent of abnormal contrast uptake and detects multiplicity. Integrated analysis provides optimal findings for proper "T" staging of breast cancer.

CESM is a recommended investigation in breast cancer to increase the accuracy of size measurement and the detection of multiple tumors. The addition of 3D ultrasound can enhance the detection of intraductal extension. Advances in knowledge: Choice of conservative breast surgery vs mastectomy is still a debate. We used an advanced, contrast-based, application of the mammogram: CESM and a non-invasive 3D breast ultrasound in the assessment of the local extension of the breast cancer regarding size, perifocal stromal infiltration and multiplicity to guide the selection of proper management in proved cases of breast cancer.