Abstract
OBJECTIVES: To evaluate the technical parameters and clinical outcomes of contrast-enhanced mammography (CEM)-guided biopsy for diagnosing breast cancer in patients with suspicious lesions showing post-contrast enhancement on CEM but undetectable on standard digital mammography (DM) or ultrasound (US). MATERIALS AND METHODS: A prospective study was conducted on 36 patients referred for CEM-guided biopsy based on suspicious (BI-RADS 4-5) enhancing-only lesions detected during previous CEM examinations and/or contrast-enhanced breast MRI (CE-MRI). Procedures were performed on a dedicated prone table using a vacuum-assisted biopsy device. Effectiveness parameters included success rate (lesion enhancement, diagnostic material collection, and correct clip positioning), procedure time, average glandular dose (AGD), compression force, and complication rate. RESULTS: From January to November 2024, 36 patients underwent CEM-guided biopsy, with a success rate of 97.2% (35/36). The median procedure time was 29 min. The AGD was 0.88 mGy (range 0.5-1.4 mGy, SD ± 0.22). The average compression force was 4.94 kg (range 2-7 kg, SD ± 1.1). Of the 35 lesions biopsied, 20 (57.1%) were masses and 15 (42.9%) non-mass enhancements, with a mean lesion size of 13.2 mm. Breast lesions were classified as BIRADS 4a (10/35), BIRADS 4b (5/35), BIRADS 4c (8/35), and BIRADS 5 (12/35). Histopathological findings showed 57.1% (20/35) of lesions were malignant. Lesion classification included 5.7% (B1), 34.3% (B2), 2.9% (B3), 31.4% (B5a), and 25.7% (B5b). CONCLUSION: CEM-guided biopsy is an effective and accessible technique for targeting enhancing-only breast lesions, offering advantages over MRI-guided biopsy in terms of time, cost, and patient comfort. CRITICAL RELEVANCE STATEMENT: Contrast-enhanced mammography-guided biopsy is an effective and accessible technique for targeting enhancing-only breast lesions, offering advantages over MRI-guided biopsy in terms of time, cost, and patient comfort. KEY POINTS: Contrast-enhanced mammography (CEM)-guided biopsy has recently gained traction as a reliable alternative to MRI for targeting enhancing-only lesions. This study explores the clinical implementation of CEM-guided biopsy in a prone position in our university hospital, assessing its efficacy, safety, and diagnostic accuracy. CEM-guided biopsy is a promising technique for the precise targeting of breast lesions, with advantages over MRI-guided biopsy.