At some point, every new imaging modality will require its own image-guided biopsy capabilities. Why? Because as Haydee Ojeda-Fournier, MD, of UC San Diego Health reminded us in her ARRS Quick Byte video, suspicious findings may be occult on all other systems.
Yes, and: Contrast-enhanced mammography (CEM) has transitioned from a purely diagnostic tool to a functional intervention platform—addressing the “what next?” problem for findings seen only on recombined images.
By the Numbers:
- 62% of CEM-detected lesions can be identified during a second look at digital breast tomosynthesis (DBT).
- 76% of CEM findings have an ultrasound correlate; these correlates are more likely to be malignant.
- ~60% of MRI-guided biopsies could potentially be performed via CEM, providing a faster, lower-cost alternative for impacted MR units.
Clinical Pearl: CEM-guided interventions are a game-changer for patients who cannot tolerate MRI. For example, in an 83-year-old patient with invasive lobular carcinoma (ILC) who was not an MRI candidate, CEM-guided localization successfully targeted a contralateral mass that was mammographically and sonographically occult.
Points of Order:
- Targeting: Using a combined scout (CEM+DBT) provides the most flexibility for choosing the optimal guidance modality.
- Approach: While both horizontal and vertical needle approaches are possible, the vertical approach is often preferred because it samples a larger tissue volume in the z-axis and is less reliant on precise depth estimation.
- Success: A “successful” biopsy is defined as obtaining tissue within one procedure under a single compression, whether guided by recombined CEM, DBT, or stereotactic techniques.
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