Radiology and Nuclear Medicine Department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain.
Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain.
Eur Radiol. 2023 Jan;33(1):417-428. doi: 10.1007/s00330-022-09021-w. Epub 2022 Jul 27.
To evaluate the feasibility of contrast-enhanced mammography (CEM)-guided biopsy at Hospital del Mar, a Spanish university hospital.
We retrospectively reviewed all consecutive women with a suspicious enhancing finding eligible for CEM-guided biopsy, who were prospectively enrolled in a pre-marketing clinical validation and feasibility study (October 2019 to September 2021). CEM-guided biopsy is a stereotactic-based procedure that, by using intravenous iodinated contrast media administration and dual-energy acquisition, provides localisation of enhancing lesions. All the biopsies were performed using a vacuum-assisted device. We collected procedural characteristics (patient position and type of approach), and histopathological results. Feasibility endpoints included success (visualisation of the enhancing lesion, post-procedural biopsy changes and clip placement), procedural time, number of scout acquisitions and complications.
A total of 66 suspicious enhancing lesions (18.0% foci, 44.0% mass, 38.0% non-mass enhancement; median size 8.5 mm) in 64 patients (median age 59 years, mostly minimal [48.4%] or mild [32.8%] background parenchymal enhancement) were referred for CEM-guided biopsy in the study period. The success rate was 63/66 (95.4%). Amongst successful procedures, patients were most frequently seated (52/63, 82.5%) and the preferred approach was horizontal (48/63, 76.2%). Median total time per procedure was 15 min. Median number of acquisitions needed before targeting was 2 (range 1-4). Complications consisted of hematoma (17/63, 27%) and vasovagal reaction (2/63, 3.2%). At histology, the malignancy rate was 25/63 (39.7%).
In this first patient series, CEM-guided breast biopsy was feasible, with success and complication rates similar to those previously reported for magnetic resonance guidance.
• CEM may be used to guide biopsy of enhancing lesions through a stereotactic-based procedure combined with intravenous iodinated contrast media administration and dual-energy acquisition. • In this first patient series (n = 64), the success rate of CEM-guided biopsy was above 95%, the only complications were hematoma (22.2%) and vasovagal reaction (3.2%), and median total time per procedure was 15 min. • CEM-guided biopsy is feasible and could potentially be a widely available biopsy technique for enhancing-only lesions.
评估在西班牙大学医院德马尔医院进行对比增强乳腺摄影（CEM）引导活检的可行性。
我们回顾性分析了所有符合 CEM 引导活检条件的可疑增强发现的连续女性患者，这些患者前瞻性地纳入了一项上市前临床验证和可行性研究（2019 年 10 月至 2021 年 9 月）。CEM 引导活检是一种基于立体定向的程序，通过静脉内碘造影剂给药和双能采集，对增强病变进行定位。所有活检均使用真空辅助装置进行。我们收集了手术过程的特征（患者体位和入路类型）和组织病理学结果。可行性终点包括成功（增强病变的可视化、术后活检改变和夹放置）、手术时间、探测采集次数和并发症。
在研究期间，共有 64 例患者（中位年龄 59 岁，大多数为轻度[48.4%]或轻度[32.8%]背景实质增强）的 66 个可疑增强病变（18.0%病灶、44.0%肿块、38.0%非肿块增强；中位大小 8.5mm）被转诊进行 CEM 引导活检。成功率为 63/66（95.4%）。在成功的手术中，患者最常采用坐姿（52/63，82.5%），首选入路为水平入路（48/63，76.2%）。每例手术的总时间中位数为 15 分钟。在靶向治疗前需要进行的采集次数中位数为 2 次（范围 1-4 次）。并发症包括血肿（17/63，27%）和血管迷走反应（2/63，3.2%）。组织学上，恶性肿瘤率为 25/63（39.7%）。
在这项首次患者系列研究中，CEM 引导的乳腺活检是可行的，成功率和并发症发生率与先前报道的磁共振引导相似。
CEM 可通过基于立体定向的程序与静脉内碘造影剂给药和双能采集相结合，用于引导增强病变的活检。
在这项首次患者系列研究（n=64）中，CEM 引导活检的成功率高于 95%，唯一的并发症是血肿（22.2%）和血管迷走反应（3.2%），每例手术的总时间中位数为 15 分钟。
CEM 引导活检是可行的，可能成为一种广泛应用于增强病变的活检技术。
