Can Contrast-Enhanced Spectral Mammography (CESM) Reduce Benign Breast Biopsy?

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• BI-RADS 4/5 lesions often lead to benign biopsies, impacting healthcare resources.
• Contrast-enhanced spectral mammography (CESM) is an emerging imaging technique for breast lesion evaluation.

Purpose of the Study:

• To assess CESM's efficacy in reducing benign breast biopsy rates.
• To explore CESM's role in managing BI-RADS 4/5 breast lesions.

Main Methods:

• Prospective study of 105 BI-RADS 4/5 lesions in 63 patients using adjunct CESM.
• Histopathologic correlation for all lesions; independent radiologist evaluation using BI-RADS classification.
• Analysis of CESM enhancement, BI-RADS scores, and histopathology for statistical significance.

Main Results:

• 22.9% of lesions showed no enhancement on CESM and were benign BI-RADS 4A.
• Of enhancing lesions, 65.1% were malignant and 34.9% benign (p < 0.05).
• CESM detected 6 additional suspicious lesions, 4 of which were malignant.

Conclusions:

• Absence of CESM enhancement strongly suggests benignity, particularly for BI-RADS 4A lesions.
• CESM can increase diagnostic confidence, potentially halving benign biopsies and improving resource allocation.
• CESM enhances detection of malignant lesions, potentially altering treatment strategies.