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Contrast-enhanced mammography-guided biopsy: principles, challenges, and opportunities
Rodrigo Alcantara1,2, Javier Azcona3, Mireia Pitarch3
1Departament de Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. ralcantara@hmar.cat.
Insights Into Imaging
|November 24, 2025
Summary
Contrast-enhanced mammography (CEM)-guided biopsy offers a feasible alternative to MRI for targeting elusive breast lesions. Further research and standardized protocols are needed for wider clinical adoption of this advanced imaging technique.
Area of Science:
- Breast imaging and interventional radiology
- Advanced diagnostic techniques in oncology
Background:
- Contrast-enhanced mammography (CEM)-guided biopsy targets enhancing breast lesions not visible on conventional imaging.
- It combines dual-energy stereotactic acquisition with contrast administration for precise lesion localization.
Purpose of the Study:
- To review the current evidence, procedural experience, and challenges of CEM-guided biopsy.
- To assess its potential as an alternative to MRI-guided biopsy.
Main Methods:
- Review of existing literature and procedural data on CEM-guided biopsy.
- Analysis of technical feasibility, lesion selection, and outcome definitions.
Main Results:
- CEM-guided biopsy is technically feasible and accurate for targeting enhancing lesions.
- Data are currently scarce and heterogeneous; implementation faces challenges like equipment, contrast protocols, and standardization.
Conclusions:
- CEM-guided biopsy shows promise in reducing reliance on MRI, especially where MRI access is limited.
- Standardized protocols, structured workflows, and prospective validation are crucial for broader clinical implementation.
