Can Contrast-Enhanced Spectral Mammography (CESM) Reduce Benign Breast Biopsy?

Figure 2

A 60-year-old woman with a palpable left breast lump. (a) Craniocaudal views of both breasts showed masses in the outer and inner halves of the right breast and a large mass associated with suspicious calcifications in the outer half of the left breast (yellow arrows). The left breast mass had yielded invasive ductal carcinoma on biopsy. (b) Selected US images of the right breast showed a stiff, solid nodule in the 0900 position of the right breast and another hypoechoic nodule with a cystic component with a mildly angular margin in the 0300 position of the right breast, corresponding to the masses seen on mammogram. In the context of biopsy proven contralateral cancer, they were initially categorized as BI-RADS 4A. (c) Subtracted CESM image in the craniocaudal view showed that both lesions in the right breast did not enhance. Note the left breast cancer showed intense enhancement. US guided biopsy of both lesions in the right breast yielded fibroadenomas. With the absence of enhancement, both of the lesions in the right breast, which were initially categorized as BI-RADS 4A, could have been downgraded to BI-RADS 3. US = ultrasound, BI-RADS = breast imaging reporting and data system and CESM = contrast-enhanced spectral mammography.

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