Objective Breast cancer is the most frequently diagnosed cancer in women. Accurate evaluation of the size and extent of the tumor is crucial in selecting a suitable surgical method for patients with breast cancer. Both overestimation and underestimation have important adverse effects on patient care. This study aimed to evaluate the accuracy of breast magnetic resonance imaging（MRI） and ultrasound（US） examination for measuring the size and extent of early-stage breast neoplasms.Methods The longest diameter of breast tumors in patients with T1–2N0–1M0 invasive breast cancer preparing for breast-conserving surgery（BCS） was measured preoperatively by using both MRI and US and their accuracy was compared with that of postoperative pathologic examination. If the diameter difference was within 2 mm, it was considered to be consistent with pathologic examination.Results A total of 36 patients were imaged using both MRI and US. The mean longest diameter of the tumors on MRI, US, and postoperative pathologic examination was 20.86 mm ± 4.09 mm（range: 11–27 mm）, 16.14 mm ± 4.91 mm（range: 6–26 mm）, and 18.36 mm ± 3.88 mm（range: 9–24 mm）. US examination underestimated the size of the tumor compared to that determined using pathologic examination（t = 3.49, P ＜ 0.01）, while MRI overestimated it（t =-6.35, P ＜ 0.01）. The linear correlation coefficients between the image measurements and pathologic tumor size were r = 0.826（P ＜ 0.01） for MRI and r = 0.645（P ＜ 0.01） for US. The rate of consistency of MRI and US compared to that with pathologic examination was 88.89% and 80.65%, respectively, and there was no statistically significant difference between them（χ~2 = 0.80, P ＞ 0.05）.Conclusion MRI and US are both effective methods to assess the size of breast tumors, and they maintain good consistency with pathologic examination. MRI has a better correlation with pathology. However, we should be careful about the risk of inaccurate size estimation.
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