Affiliation:
1. Department of Medical Imaging Royal Perth Hospital Perth Western Australia Australia
2. Department of Anatomical Pathology, PathWest Royal Perth Hospital Perth Western Australia Australia
3. University of Western Australia Medical School Perth Western Australia Australia
4. Breast Screen Western Australia 233 Adelaide Terrace Perth Western Australia Australia
Abstract
AbstractIntroductionContrast‐enhanced mammography (CEM) and MRI detect ‘contrast‐only’ lesions (COLs) occult on standard breast imaging (ultrasound and conventional mammography). Until recently, MRI was the only reliable method of biopsy. This study presents the first Australian experience with CEM‐guided biopsy (CEMBx) and the lessons learnt.MethodsA prospective audit of the first 15 consecutive patients who underwent CEMBx for COLs was performed. Indications for contrast imaging, patient and lesion characteristics, procedural details, radiation dose and pathology data were collected.ResultsThe 15 women were aged 37–81 years (mean 59 years). Indications for contrast imaging were problem solving (n = 3), moderate risk screening (n = 2), cancer staging (n = 9) and symptoms (n = 1). The COLs were non‐mass (n = 14), mass (n = 1) and an enhancing asymmetry (n = 1). For one patient, two lesions were sampled during the same event. All lesions enhanced and were successfully sampled followed by marker clip insertion. Most biopsies (87.5%) were performed with the breast in cranio‐caudal compression using a horizontal approach. Procedural duration ranged from 13 to 33 min (mean 22 min). Radiation dose was similar to standard stereotactic biopsy. Post‐biopsy hematomas occurred in three patients, none required intervention. Clip displacement occurred in three cases. Core biopsy histopathology results were benign (n = 8), malignant (n = 7) and a borderline breast lesion (BBL) (n = 1). Patient satisfaction rates were high. Imaging follow‐up is ongoing.ConclusionsCEMBx is a quick, safe and reliable alternative to MRIBx to sample COLs.