Contrast-enhanced mammography-guided biopsy and localization: initial outcome and a single institution's experience

Contrast-enhanced mammography (CEM) has emerged as a highly sensitive modality for detecting breast lesions, particularly those occult on conventional imaging. Although CEM-guided vacuum-assisted biopsy (VAB) has been established as a feasible technique, there are no prior reports about the use of CEM-guided core needle biopsy (CNB) or wire localization (WL). This study, therefore, aimed to describe our center's initial outcome of CEM-guided CNB and WL for breast enhancing lesions.

This retrospective study included 35 lesions of 35 patients who underwent CEM-guided CNB and WL between December 2023 and March 2025 at a single institution. Patient and lesion characteristics, procedural features, and pathology data were recorded.

The 35 women were aged 28-67 years (mean 48.7 years). The success rate of CEM-guided procedure was 100.0%, and complications occurred in 2 cases (5.7%, 2/35) with minor hematomas. The mean size of lesions was 2.1±1.9 cm, with 17 (48.6%) enhancing lesions as masses and the remaining 18 (51.4%) lesions as non-mass enhancement (NME). All procedures were performed using a vertical approach. Of the 35 CEM-enhancing lesions, 24 lesions underwent CEM-guided CNB and 11 lesions underwent CEM-guided WL. For CEM-guided CNB, the mean procedure time was 14.2±3.4 min. The mean average glandular dose (AGD) for a single acquisition was 2.2±0.2 mGy and the mean AGD was 9.3±2.6 mGy per procedure. For CEM-guided WL, the mean procedure time was 12.4±2.8 min. The mean AGD for a single acquisition was 2.1±0.4 mGy and the mean AGD per procedure was 15.6±3.2 mGy.

CEM-guided procedure demonstrates promising potential for enhancing lesions, with high rates of success, short operation time, and fewer complications in this preliminary study; however, these findings require further validation in larger sample sizes.