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Contrast-Enhanced Mammography-Guided Biopsy for MRI-Detected Breast Lesions: A Prospective Study
Yuying Cao1, Amy H Lu2, Ryan Cecil3
1School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Journal of Breast Imaging
|February 9, 2026
Summary
Contrast-enhanced mammography biopsy (CEM-Bx) successfully targets MRI-suspicious breast lesions lacking other imaging correlates. Factors like lesion size and radiologist experience influence CEM-Bx success rates.
Area of Science:
- Radiology
- Breast Imaging
- Interventional Radiology
Background:
- MRI is crucial for detecting breast lesions, but biopsy guidance can be challenging for lesions without sonographic or tomosynthetic correlation.
- Contrast-enhanced mammography biopsy (CEM-Bx) offers a potential alternative for these difficult-to-biopsy lesions.
Purpose of the Study:
- To evaluate the success rate of CEM-Bx for MRI-detected breast lesions without tomosynthesis or ultrasound correlation.
- To identify factors associated with successful CEM-Bx in this patient cohort.
Main Methods:
- A prospective study included women with BI-RADS ≥4A MRI lesions undergoing CEM-Bx.
- CEM was performed, followed immediately by CEM-Bx if a correlate was visualized.
- Success was defined by visualization of an enhancing correlate and accurate lesion sampling; failures proceeded to MRI-guided biopsy.
Main Results:
- CEM-Bx was successful in 57.6% of 184 lesions across 152 women.
- Malignancy was found in 22.6% of successful biopsies and 17.9% of failures.
- Factors associated with CEM-Bx success included larger lesion size, increased radiologist CEM experience, and lower background parenchymal enhancement (BPE).
Conclusions:
- CEM-Bx is a viable alternative to MRI-guided biopsy for specific MRI-detected breast lesions.
- MRI-guided biopsy remains essential for cases where CEM-Bx is unsuccessful.
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