Contrast-enhanced mammography-guided biopsy in a prone position in the diagnosis of breast cancer: technical parameters and clinical outcomes

ObjectivesTo 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 methodsA 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.ResultsFrom 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).ConclusionCEM-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 statementContrast-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 PointsContrast-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.