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

Figure 3

Example of 2 cases where the addition of CESM had helped in the clinical management of contentious BI-RADS 4 lesions. Both patients had prior wide local excision for malignancy and presented with a new palpable lump in the ipsilateral breast. (a) Selected US image in the first participant showed a new, lobulated hypoechoic nodule with cystic component. (b) It did not enhance on CESM and US-guided biopsy yielded benign histology. Subsequent follow-ups after 4 years showed a stable lesion. (c) Selected US image in another participant showed a new, irregular, nonparallel, hypoechoic nodule with angular margins. (d) It showed moderate to intense enhancement on CESM. A free-hand biopsy previously performed by the surgeon had yielded a benign result. Imaging features and the presence of moderate to intense enhancement on CESM had enabled the radiologist to confidently deem the result to be discordant. A repeat biopsy was performed under US guidance, and the lesion was indeed proven to be malignant. US = ultrasound and CESM = contrast-enhanced spectral mammography.

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