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. 2025 Sep 22;17(18):3086.
doi: 10.3390/cancers17183086.

Contrast-Enhanced Mammography-Guided Biopsy in Patients with Extensive Suspicious Microcalcifications

Yun-Chung Cheung  1 , Wai-Shan Chung  2 , Ya-Chun Tang  1 , Chia-Wei Li  3
Affiliations

Contrast-Enhanced Mammography-Guided Biopsy in Patients with Extensive Suspicious Microcalcifications

Yun-Chung Cheung et al. Cancers (Basel). .

Abstract

Objectives: To investigate the feasibility of contrast-enhanced mammography-guided biopsy (CEM-Bx) to diagnose cancer via targeting the associated enhancements in the patients with extensive suspicious microcalcifications. Methods: All the women with extensive suspicious microcalcifications were mammographically screened. Contrast-enhanced mammography was first examined, followed by CEM-Bx if there was any relevant enhancement; otherwise, patients without enhancement were submitted to conventional mammography-guided biopsy (MG-Bx). We recorded and analyzed the histological results, morphologies and distributions of the microcalcifications. The outcomes were also compared to those patients (control group) who did not assess with CEM and received MG-Bx only by the Wilcoxon rank-sum test. Results: Between November 2021 and November 2023, a total of 61 participants participated in the test. A total of 26 women underwent CEM-Bx, and 35 underwent MG-Bx. In total, 19 of the 26 CEM-Bx were diagnosed as cancer, and none by MG-Bx. The cancer diagnostic rates (CDRs) identified by CEM-Bx were 81.8% for regional microcalcifications and 66.7% for segmental or diffuse distributions. The CDR of the test group was higher than the control group, 31.4% to 20%, respectively. Otherwise, the CDR of CEM-Bx was significantly higher than MG-Bx in the control group (73.08% to 20%, p-valve < 0.01). Conclusions: CEM-Bx was a safe and feasible procedure. With identification of the enhanced target, CEM-Bx faithfully performed among the extensive distributed suspicious microcalcifications. Although CEM-Bx improves CDR, larger prospective trials with surgical validation of all lesions are needed before widespread adoption.

Keywords: breast cancer; breast microcalcifications; contrast-enhanced mammography; contrast-enhanced mammography guided biopsy; diagnosis; mammography.

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Conflict of interest statement

Author Chia-Wei Li was employed by the company GE HealthCare. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Diagnostic schema of the test and control groups.
Figure 2
Figure 2
A 52-year-old woman with diffuse of amorphous and pleomorphous microcalcifications: The CEM-Bx and surgical results were both diagnosed to DCIS. (a) The LM (craniocaudal view) showed suspicious microcalcifications scattering in the outer region of left breast. (b) The REI (craniocaudal view) showed the presence of regional relevant enhancement in the outer region of left breast. (c) The pre-biopsy LM (craniocaudal view) localized the suspicious microcalcifications. (d) The pre-biopsy REI (craniocaudal view) revealed non-mass infiltrating enhancement. (e) The LM (craniocaudal view) showed the horizontal approach of biopsy needle beneath the target enhancement before firing the needle. (f) A ribbon-shape marker was placed at the biopsy site after CEM-Bx.
Figure 2
Figure 2
A 52-year-old woman with diffuse of amorphous and pleomorphous microcalcifications: The CEM-Bx and surgical results were both diagnosed to DCIS. (a) The LM (craniocaudal view) showed suspicious microcalcifications scattering in the outer region of left breast. (b) The REI (craniocaudal view) showed the presence of regional relevant enhancement in the outer region of left breast. (c) The pre-biopsy LM (craniocaudal view) localized the suspicious microcalcifications. (d) The pre-biopsy REI (craniocaudal view) revealed non-mass infiltrating enhancement. (e) The LM (craniocaudal view) showed the horizontal approach of biopsy needle beneath the target enhancement before firing the needle. (f) A ribbon-shape marker was placed at the biopsy site after CEM-Bx.
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