Distinction-enhanced mammography (CEM)-guided biopsy by itself will not be an excellent substitute for MRI-guided biopsy of suspicious breast MRI findings, in keeping with a examine revealed September 18 within the American Journal of Roentgenology.
Researchers led by Michael Morris, MD, from Banner MD Anderson Most cancers Heart in Gilbert, AZ, reported that greater than one-quarter of suspicious MRI findings deemed to be occult at tried CEM-guided biopsy have been identified as malignant by subsequent MRI-guided biopsy.
“Within the present state, CEM-guided biopsy shouldn’t be prolonged to the biopsy of suspicious findings on MRI,” Morris instructed AuntMinnie.com.
MRI-guided breast biopsy is efficient for the workup of suspicious MRI findings. Nevertheless, the researchers famous that it’s a time-consuming and resource-intensive process. Latest analysis has highlighted the potential of CEM as an alternative choice to MRI in diagnostic imaging by way of imaging accuracy and affected person accessibility, and the approach has been explored instead sampling technique for enhancing lesions.
Morris and colleagues evaluated their establishment’s expertise in performing preliminary tried CEM-guided biopsy for suspicious breast MRI findings.
The examine included information collected in 2023 and 2024 from 155 ladies who underwent breast MRI assessed as BI-RADS 4 or 5. Of the entire cohort, 73 obtained the choice for tried CEM-guided biopsy, with 21 present process it. Two breast radiologists with 12 and 13 years of post-training expertise independently reviewed photos from accomplished CEM-guided and MRI-guided biopsies.
(A, B) Photographs depict a 65-year-old girl with prior left malignant lumpectomy. (A) Sagittal fat-suppressed contrast-enhanced T1-weighted picture from diagnostic MRI carried out for clear left nipple discharge reveals segmental nonmass enhancement (NME) (arrows), deemed suspicious with evaluation as BI-RADS class 4. The affected person elected to bear tried contrast-enhanced mammography (CEM)-guided biopsy quite than direct MRI-guided biopsy. (B) Recombined scout picture from tried CEM-guided biopsy reveals corresponding NME (arrows), serving because the biopsy goal. CEM-guided biopsy was accomplished. Histologic evaluation yielded benign findings, deemed concordant by the performing radiologist. (C,D) Photographs depict a 55-year-old girl with left breast invasive ductal carcinoma (IDC). (C) Sagittal fat-suppressed contrast-enhanced T1-weighted MR picture from staging MRI reveals recognized IDC (arrowhead) and extra 4-mm NME (arrow), deemed suspicious with evaluation as BI-RADS class 4. Solely NME was thought-about to symbolize a suspicious discovering warranting biopsy. The affected person elected to bear tried CEM-guided biopsy quite than direct MRI-guided biopsy. (D) Recombined scout picture from tried CEM-guided biopsy reveals an enhancement of recognized IDC (arrowhead). Suspicious NME will not be visualized. Given the absence of a CEM correlate to function biopsy goal, CEM-guided biopsy was canceled. Subsequent MRI-guided biopsy of suspicious NME was accomplished; histologic evaluation yielded IDC, deemed concordant by the performing radiologist. Picture courtesy of the ARRS.
Six of the 21 ladies had a biopsy goal recognized by CEM and underwent CEM-guided biopsy; all of those have been benign. The remaining 15 ladies lacked a CEM correlate to function a biopsy goal and CEM-guided biopsy was canceled after CEM was continued for a mean of 8.5 minutes.
These 15 ladies underwent MRI-guided biopsy. Of those, 13 accomplished the MRI-guided biopsy, which yielded the next findings: eight benign findings, two high-risk lesions, two invasive ductal carcinomas, and one ductal carcinoma in situ (DCIS). This yielded an total malignancy fee of 27%.
The radiologists deemed all accomplished CEM-guided and MRI-guided biopsies concordant. After CEM-guided biopsy, three ladies underwent diagnostic mammography and one underwent CEM six months post-biopsy, all with out suspicious findings.
The crew additionally assessed goal conspicuity within the six ladies who underwent accomplished CEM-guided biopsy and the 13 who underwent MRI-guided biopsy, utilizing a 5-point Likert scale to measure conspicuity. Median goal conspicuity for CEM and MRI for each readers was 1 and three.
Lastly, among the many 15 ladies with canceled CEM-guided biopsy, each readers recognized one CEM goal comparable to the suspicious MRI discovering that was not acknowledged prospectively. MRI-guided biopsy deemed this lesion to be malignant.
Morris mentioned the crew will subsequent discover two areas in CEM-guided biopsy: Figuring out whether or not rising iodine load by rising distinction quantity will enhance goal conspicuity and exploring how adjustments to the CEM post-processing algorithm impression goal conspicuity.
“Over time, the training curve for operators [radiologists and technologists] could enhance CEM-guided biopsy methods and evolving post-processing algorithms could enhance CEM goal conspicuity,” Morris instructed AuntMinnie.com.
The complete examine may be accessed right here.
