Contrast-Enhanced Stereotactic Biopsy (CESB): Patient selection and practical considerations

Eur J Radiol. 2024 Dec:181:111768. doi: 10.1016/j.ejrad.2024.111768. Epub 2024 Sep 28.

Abstract

Since its introduction in 2012, contrast-enhanced mammography (CEM) has shown increased clinical relevance as a diagnostic tool in breast imaging. Its diagnostic accuracy is on par with breast MRI, rendering it a viable and potentially cost-effective alternative for breast MRI indications, especially in areas with lower accessibility to MRI. Like MRI, CEM occasionally shows 'CEM-only' lesions, i.e., areas of contrast enhancement without corresponding findings on low-energy images, ultrasound, or digital tomosynthesis. The current workaround usually consists of performing MRI-guided biopsy. However, contrast-enhanced stereotactic biopsy (CESB) offers a new alternative and has become commercially available since 2020. This narrative review will outline patient selection, the procedure, important considerations when performing CESB, and an overview of current literature.

Keywords: Biopsy; Breast neoplasm; Contrast agents; Mammography.

Publication types

  • Review
  • Letter

MeSH terms

  • Breast Neoplasms* / diagnostic imaging
  • Breast Neoplasms* / pathology
  • Contrast Media*
  • Female
  • Humans
  • Image-Guided Biopsy* / methods
  • Mammography / methods
  • Patient Selection*
  • Stereotaxic Techniques

Substances

  • Contrast Media