PurposeThis single-centre study includes a comparative analysis of the diagnostic performance of contrast-enhanced mammography (CEM) and automatic breast ultrasound (ABUS). The study involved 81 patients with focal breast lesions, who underwent ABUS, full-field digital mammography (FFDM), and CEM.Material and methodsA total of 169 focal lesions were found in 81 patients, of which 110 lesions were histopatholo­gically verified, 92 were malignant, 5 were B3 lesions, and 13 were benign. On CEM 19 additional lesions not visible on other imaging examinations were found, and as many as 36 new lesions were detected on ABUS. The number of lesions detected in patients with multiple lesions were 106 from 169 on ABUS, 65 on FFDM, and 88 on CEM. The highest correlation between the lesion’s margin and its histopathological character was found in FFDM (p < 0.00), then ABUS (p = 0.038), and the lowest in CEM (p = 0.043). Compliance in determining the lesions’ size comparing to histopathology as a gold standard was the highest for ABUS (p = 0.258) and lower for CEM (p = 0.012).ResultsThe sensitivity of ABUS, FFDM, and CEM was, respectively: 80.43, 90.22, and 93.48; specificity: 27.78, 11.11, and 11.11; positive predictive value (PPV): 85.06, 83.84, and 84.31; negative predictive value (NPV): 21.74, 18.18, and 25; and accuracy: 71.82, 77.27, and 80. The sensitivity and accuracy of the combination of FFDM and ABUS were, respectively, 100 (p = 0.02) and 84.55 (AUC = 0.947) and for the combination of FFDM + CEM 93.48 (p = 0.25) and 79.09 (AUC = 0.855).ConclusionsThe study confirms that both ABUS and CEM may serve as a valuable complementary method for FFDM.