Practical Guide to Percutaneous Biopsy with Contrast-Enhanced Mammography: From Planning to Post-Procedural Management

Contrast-enhanced mammography-guided biopsy (CEM-guided biopsy) is an emerging minimally invasive technique for the diagnosis of enhancing breast lesions visible only after contrast administration. Traditionally, these lesions required magnetic resonance imaging (MRI)-guided biopsy, which may be limited by high costs, reduced accessibility, prolonged procedure times, and patient-related contraindications. This review aims to provide a practical and updated overview of CEM-guided biopsy, focusing on procedural workflow, technical execution, patient preparation, and complication management in daily clinical practice. A narrative review of the current literature on CEM-guided biopsy was performed, focusing on technical feasibility, procedural protocols, patient management, diagnostic performance, and reported complications. This review integrates evidence from recent clinical studies and practical considerations derived from interventional breast imaging practice. Early clinical experiences demonstrate high technical success rates for CEM-guided biopsy, with procedure times generally shorter than those reported for MRI-guided biopsy. However, formal measures of diagnostic accuracy have not been consistently reported across the available studies. Key procedural aspects include pre-procedural imaging evaluation, contrast administration timing, lesion targeting on recombined images, patient positioning, vacuum-assisted biopsy techniques, and post-procedural care. Reported complication rates are low and comparable to those of conventional stereotactic biopsy procedures. CEM-guided biopsy represents a promising alternative to MRI-guided breast biopsy, offering a faster, more accessible, and well-tolerated approach for sampling enhancing-only breast lesions. Although current evidence remains limited and heterogeneous, this technique may facilitate wider implementation of contrast-enhanced image-guided breast interventions. Standardized protocols and larger multicenter studies are still needed to validate its broader clinical role.