Challenging Contrast-Enhanced Mammography-Guided Biopsies: Practical Approach Using Real-Time Multimodality Imaging and a Proposed Procedural Algorithm

Contrast-enhanced mammography (CEM) is an emerging functional breast imaging technique that entails the acquisition of dual-energy digital mammographic images after IV administration of iodine-based contrast material. CEM-guided biopsy technology was introduced in 2019 and approved by the U.S. FDA in 2020. This technology's availability enables direct sampling of suspicious enhancement seen only on or predominantly on recombined CEM images and addresses a major obstacle to the clinical implementation of CEM technology. The literature describing clinical indications and procedural techniques of CEM-guided biopsy is scarce. This article describes our initial experience in performing challenging CEM-guided biopsies and proposes a step-by-step procedural algorithm designed to proactively address anticipated technical difficulties and thereby increase the likelihood of achieving successful targeting.

Automated summary

Contrast-enhanced mammography (CEM) is a promising breast imaging technique that uses dual-energy digital mammographic images with the help of intravenous iodine-based contrast material. CEM-guided biopsy, introduced in 2019 and approved by the U.S. FDA in 2020, allows direct sampling of suspicious enhancements visible on or predominantly on recombined CEM images. This article presents our initial experience and suggests a procedural algorithm to address technical difficulties and improve targeting success.