Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes

Abstract

Objectives To evaluate the feasibility of contrast-enhanced mammography (CEM)-guided biopsy at Hospital del Mar, a Spanish university hospital. Methods We retrospectively reviewed all consecutive women with a suspicious enhancing finding eligible for CEM-guided biopsy, who were prospectively enrolled in a pre-marketing clinical validation and feasibility study (October 2019 to September 2021). CEM-guided biopsy is a stereotactic-based procedure that, by using intravenous iodinated contrast media administration and dual-energy acquisition, provides localisation of enhancing lesions. All the biopsies were performed using a vacuum-assisted device. We collected procedural characteristics (patient position and type of approach), and histopathological results. Feasibility endpoints included success (visualisation of the enhancing lesion, post-procedural biopsy changes and clip placement), procedural time, number of scout acquisitions and complications. Results A total of 66 suspicious enhancing lesions (18.0% foci, 44.0% mass, 38.0% non-mass enhancement; median size 8.5 mm) in 64 patients (median age 59 years, mostly minimal [48.4%] or mild [32.8%] background parenchymal enhancement) were referred for CEM-guided biopsy in the study period. The success rate was 63/66 (95.4%). Amongst successful procedures, patients were most frequently seated (52/63, 82.5%) and the preferred approach was horizontal (48/63, 76.2%). Median total time per procedure was 15 min. Median number of acquisitions needed before targeting was 2 (range 1–4). Complications consisted of hematoma (17/63, 27%) and vasovagal reaction (2/63, 3.2%). At histology, the malignancy rate was 25/63 (39.7%). Conclusion In this first patient series, CEM-guided breast biopsy was feasible, with success and complication rates similar to those previously reported for magnetic resonance guidance. Key points • CEM may be used to guide biopsy of enhancing lesions through a stereotactic-based procedure combined with intravenous iodinated contrast media administration and dual-energy acquisition. • In this first patient series (n = 64), the success rate of CEM-guided biopsy was above 95%, the only complications were hematoma (22.2%) and vasovagal reaction (3.2%), and median total time per procedure was 15 min. • CEM-guided biopsy is feasible and could potentially be a widely available biopsy technique for enhancing-only lesions.

Contrast Enhanced Mammography (CEM) Enhancing Asymmetry: Single-Center First Case Analysis

“…However,, it would have been preferred to better target the EA to put them under biopsy. As a matter of fact, there have been preliminary studies supporting CEM-guided biopsy compared to an MRI-guided one, as in R. Alcantara et al, who first stated it, and Schiaffino S. and Cozzi A., who later emphasized that CEM-guided breast biopsy had success and complication rates similar to those reported for magnetic resonance guidance, ensuring fast, low-cost, and effective tissue sampling of the CEM-detected lesions [ 12 , 13 ].…”

“…The EAs without any correlate underwent MRI with contrast medium due to the current unavailability at our center of CEM-guided biopsy, which would have been preferred [ 12 , 13 ]. The MRIs were classified and managed according to the BI-RADS criteria of breast MRI [ 7 ].…”

Contrast-enhanced mammography-guided biopsy: why, when, and where we need it

“…Conversely, CEM-guided biopsy combines morpho-functional lesion visualization with the versatility and accessibility of stereotactic guidance and of upright and lateral decubitus positioning. Of note, the success rate achieved by Alcantara et al [4] exceeds 95% without any exclusion of early cases and within a diverse lesion presentation (almost 40% of biopsied findings appeared as nonmass enhancement). Thus, the first (and possibly the major) rationale and scope of CEM-biopsy application could be determined by its ability to allow for easy and prompt sampling of MRIdetected lesions, avoiding the dilemma of having to curtail the number of screening MRI examinations in order to accommodate MRI-guided biopsies in already crammed MRI schedules.…”

“…Alcantara et al [4] also hint other aspects that will favour CEM-guided biopsy: its stereotactic approach makes it already faster than MRI-guided biopsy (with a median 15 min procedure time, compared to 30-40 min ranges commonly reported for MRI-guided biopsy) and will likely imply a lower occurrence of clip migration [10]. Moreover, the lesion nonvisualization rate at procedural CEM (4.5%) was also already lower than the 8-13% estimates reported for MRIguided biopsy [10].…”

“…This is also the case for the newest addition to the roster of imaging-based guidance options for percutaneous breast biopsy, contrast-enhanced mammography (CEM). Besides a handful of case reports [1][2][3], the article by Alcantara et al [4] describes the first multi-case series of CEM-guided biopsy and suggests how the benefits of this application of CEM may be even greater than those associated to its diagnostic use.…”