Contrast-enhanced Mammography-guided Biopsy: Initial Trial and Experience

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Contrast-enhanced mammography (CEM) offers improved visualization of enhancing breast lesions compared to standard mammography.
• CEM-guided biopsy aims to increase diagnostic accuracy by targeting suspicious enhancing areas.

Purpose of the Study:

• To evaluate lesion visibility and radiologist confidence during contrast-enhanced mammography (CEM)-guided biopsy.
• To assess the feasibility and clinical implementation of CEM-guided biopsy.

Main Methods:

• Prospective recruitment of women with BI-RADS ≥4A enhancing breast lesions for vacuum-assisted CEM-guided biopsy.
• Collection of data on breast density, background parenchymal enhancement (BPE), lesion characteristics, radiologist confidence (1-5 scale), and acquisition times.
• Analysis of signal intensities in specimens and patient surveys.

Main Results:

• 28 women (average age 57) with 28 enhancing lesions (25% malignant) underwent CEM-guided biopsy.
• Lesion enhancement persisted through post-procedure mammography (PPM) and was visible on low-energy specimen radiography (96% visibility).
• Average radiologist confidence score was 2.2 (SD=1.2), indicating moderate confidence; patients reported positive assessments.

Conclusions:

• CEM-guided breast biopsy is easily implemented clinically, with lesion enhancement persisting through PPM and visible on specimen radiography.
• The availability and successful implementation of CEM-guided biopsy are expected to encourage wider adoption of CEM.
• CEM-guided biopsy demonstrates potential for improved targeting and assessment of enhancing breast lesions.