Contrast-Enhanced Mammography-Guided Biopsy for MRI-Detected Breast Lesions: A Prospective Study

To determine the contrast-enhanced mammography-guided biopsy (CEM-Bx) success rate for MRI-suspicious lesions lacking known tomosynthetic or sonographic correlate along with factors associated with biopsy success.

From June 2022 to August 2023, this prospective IRB-approved study enrolled women with breast MRI lesions rated BI-RADS ≥4A for CEM-Bx. Ipsilateral contrast-enhanced mammography (CEM) was performed in the biopsy suite and correlated with MRI. For visible lesions, CEM-Bx was performed immediately after prebiopsy CEM. Success criteria included enhancing correlate visualization and biopsy completion with accurate lesion sampling. An MRI-guided biopsy was recommended for failures. The success rate was evaluated with the Wilson score interval. MRI lesion and patient characteristics (size, type [mass, focus, or nonmass enhancement], kinetics, breast density, body mass index, background parenchymal enhancement [BPE], radiologist CEM experience, radiologist MRI experience, and histopathology) were collected. Multivariable logistic regression was performed with backward feature selection.

Analysis included 152 women (mean age 53 ± 11 years) with 184 lesions. CEM-Bx was successful for 106/184 (57.6%; [95% CI, 50.0-65.0]) lesions with 24/106 (22.6%) malignant. Of 78 failures, 60 (76.9%) lacked enhancement on prebiopsy CEM, 14 (17.9%) were not visualized with the biopsy grid, and 4 (5.1%) were not accurately sampled; 14/78 (17.9%) failures proved malignant. Increasing lesion size (odds ratio [OR] = 1.03; [95% CI, 1.01-1.06]), more years of radiologist CEM experience (OR = 1.24; [95% CI, 1.01-1.49]), and lower BPE (OR = 0.68 [95% CI, 0.46-0.98]) were associated with success.

Contrast-enhanced mammography biopsy can be a successful alternative to MRI-guided biopsy for MRI-detected lesions. MRI-guided biopsy should be pursued if CEM-Bx fails.