Contrast-Enhanced Mammography-Guided Biopsy: A Step-by-Step Guide

Although contrast-enhanced mammography (CEM) is not yet approved by the U.S. FDA for screening, diagnostic use of CEM as an alternative to breast MRI is becoming more widely accepted. CEM-guided biopsy has emerged as a modified stereotactic biopsy approach for sampling suspicious enhancing lesions that are visible only on recombined CEM images, and direct CEM-guided biopsy is becoming increasingly recognized as an essential component of efficient CEM workflows. Implementation of CEM-guided biopsy remains in its early stages, and further efforts from breast imagers and vendors will be required to optimize the technical quality of imaging and targeting during CEM-guided biopsy, to maximize the usefulness of the procedure and thereby the usefulness of CEM itself. In this Clinical Perspective, we explore the current status of CEM-guided biopsy based on relevant literature and the authors' clinical experience. We summarize indications and techniques and provide practical tips for performing these procedures, including step-by-step guidance, troubleshooting suggestions, and alternative approaches.