A RECENT study suggests that contrast-enhanced mammography (CEM)-guided biopsy is not a suitable substitute for MRI-guided biopsy in evaluating suspicious breast MRI findings. The research, led by Michael Morris, Banner MD Anderson Cancer Centre, Gilbert, Arizona, USA, highlights key limitations of CEM-guided biopsy in accurately detecting malignant lesions identified on breast MRI.
MRI-guided biopsy is the standard for assessing suspicious MRI findings, but it is a resource-intensive and time-consuming process. CEM has been explored as a more accessible alternative due to its potential in diagnostic imaging. However, the study demonstrated that CEM-guided biopsy does not perform well in this capacity.
The study analysed data from 155 women who underwent breast MRI assessed as BI-RADS 4 or 5. Out of these, 73 were given the option of attempting CEM-guided biopsy, with 21 undergoing the procedure. Two experienced breast radiologists reviewed the imaging results and found that, of the 21 women who opted for CEM-guided biopsy, only six had biopsy targets identified on CEM, and all biopsies revealed benign findings. However, for the remaining 15 women, no viable target was found on CEM, leading to cancelled procedures after a median scanning time of 8.5 minutes.
Subsequently, 13 of these 15 women underwent MRI-guided biopsy, which revealed that four had malignant lesions, including invasive ductal carcinomas and ductal carcinoma in situ (DCIS). This resulted in a 27% malignancy rate for suspicious MRI findings that CEM failed to detect. The researchers also evaluated target conspicuity on a 5-point Likert scale, with MRI consistently outperforming CEM in identifying biopsy targets. The study concluded that CEM-guided biopsy, in its current state, is not reliable for suspicious MRI findings and should not be used as a substitute for MRI-guided biopsy.
Moving forward, the researchers plan to explore whether increasing iodine contrast volume or refining CEM post-processing algorithms could improve target conspicuity and make CEM-guided biopsy a more viable option.
Katie Wright, EMJ
Reference
Morris MF et al. Initial attempted contrast-enhanced mammography-guided biopsy for suspicious breast MRI findings: a single institution’s experience. AJR Am J Roentgenol. Published online September 18, 2024. doi:10.2214/AJR.24.31940.
