Abstract Objective To determine the contrast-enhanced mammography-guided biopsy (CEM-Bx) success rate for MRI-suspicious lesions lacking known tomosynthetic or sonographic correlate along with factors associated with biopsy success. Methods From June 2022 to August 2023, this prospective IRB-approved study enrolled women with breast MRI lesions rated BI-RADS ≥4A for CEM-Bx. Ipsilateral contrast-enhanced mammography (CEM) was performed in the biopsy suite and correlated with MRI. For visible lesions, CEM-Bx was performed immediately after prebiopsy CEM. Success criteria included enhancing correlate visualization and biopsy completion with accurate lesion sampling. An MRI-guided biopsy was recommended for failures. The success rate was evaluated with the Wilson score interval. MRI lesion and patient characteristics (size, type mass, focus, or nonmass enhancement, kinetics, breast density, body mass index, background parenchymal enhancement BPE, radiologist CEM experience, radiologist MRI experience, and histopathology) were collected. Multivariable logistic regression was performed with backward feature selection. Results Analysis included 152 women (mean age 53 ± 11 years) with 184 lesions. CEM-Bx was successful for 106/184 (57.6%; 95% CI, 50.0-65.0) lesions with 24/106 (22.6%) malignant. Of 78 failures, 60 (76.9%) lacked enhancement on prebiopsy CEM, 14 (17.9%) were not visualized with the biopsy grid, and 4 (5.1%) were not accurately sampled; 14/78 (17.9%) failures proved malignant. Increasing lesion size (odds ratio OR = 1.03; 95% CI, 1.01-1.06), more years of radiologist CEM experience (OR = 1.24; 95% CI, 1.01-1.49), and lower BPE (OR = 0.68 95% CI, 0.46-0.98) were associated with success. Conclusion Contrast-enhanced mammography biopsy can be a successful alternative to MRI-guided biopsy for MRI-detected lesions. MRI-guided biopsy should be pursued if CEM-Bx fails.
Cao et al. (Thu,) studied this question.