CESM: The Latest Tool for Faster and Easier Breast Biopsies

For most women, breast mammograms are routine — a test and a negative report. For others, the results are unclear; something is spotted and more images may be needed. Traditionally, the additional workup would include additional mammogram pictures followed by ultrasound. If results were still indeterminate, a breast MRI could be performed.

Within recent years, a new technology called contrast-enhanced spectral mammography (CESM) was developed as an additional tool to solve indeterminate cases.

Avera was one of the first hospitals to use this new technology as a diagnostic tool. Even more recently, CESM has become a way that we can image the breast and perform a biopsy of a suspicious area.

“We are one of only a few health care entities to offer this new technology currently, but I believe this will become standard care around the country in only a few years,” said Daniel Sova, MD, radiologist at Avera Breast Center.

How CESM-Guided Breast Biopsy Works

CESM is most often used when routine mammography comes back inconclusive. The patient receives a contrast dye via IV through the arm. On screen, the contrast lights up potential abnormalities in the breast that were not distinguishable with conventional mammography, differentiating any suspicious lesions from normal breast tissue.

Through a combination of low- and high-energy X-rays, the contrast agent highlights areas where there is increased blood flow — a sign that can be associated with cancer.

If a biopsy is needed, the radiologist can use the CESM image to guide a sampling needle to the precise location of the suspicious area and extract the cells for testing.

This is an outpatient procedure and no sedation is necessary; only local anesthetic is needed. In total, the procedure takes less than 15 minutes.

Who Should Use CESM-Guided Breast Biopsy

Typically, the patients who undergo CESM are those with dense breast tissue or scarring, which doesn’t easily allow radiologists to see the concerning areas, said Rhonda Engebretson, Breast Health Manager at Avera Breast Center.

“The danger of not finding breast abnormalities right away is that it delays diagnosis and allows a cancer to grow,” said Sova. “Metastatic cancer is devastating.”

Benefits of CESM Breast Cancer Biopsy

The benefits of CESM technology offer a combination of simplicity and accuracy for both the patient and the surgeon. Benefits include:

• Saving money. CESM-guided biopsy costs significantly less than MRI-guided biopsy, which was the traditional way to biopsy occult lesions. Check your health plan for potential out-of-pocket cost.
• Comfort for patient. During an MRI-guided breast biopsy, the patient lies on her stomach. For the CESM-guided biopsy, she sits in a chair like a regular mammo for the images and biopsy.
• Shorter duration. Likewise, the CESM-guided biopsy takes barely longer than a regular mammo, while the MRI-guided biopsy could take nearly an hour.
• Accurate needle placement. The contrast dye easily shows the radiologist where the needle needs to be inserted in the breast to withdraw the biopsy.

Dense Breast Tissue Leads to CESM Biopsy for Patient

Before turning 41, Shannon Haugen scheduled her first mammogram at Avera Marshall. She received a callback to have further imaging done. The new imaging determined she needed an ultrasound-guided needle biopsy the next week.

Atypical cells with the suspicion of carcinoma led to a referral at the Avera Breast Center in Sioux Falls. A regular CESM mammo and ultrasound revealed that two areas needed to be biopsied and removed. She had further surgery to ensure her breasts looked and felt symmetrical.

“We discovered I had lobular carcinoma in situ, which puts me at higher risk for future breast cancer,” Haugen explained.

During her routine mammogram a year later, only one area needed to be biopsied. The CESM-guided biopsy took a tissue sample, but no cancer was detected after testing.

The whole experience proved to be a positive one for her. “The screening went quickly and I didn’t have bruising from the biopsies,” Haugen said. “All the samples came back clear.”

“I don’t have a family history, so it’s scary to get that follow-up call,” said Haugen. “However, I want my experience to provide education and encourage women to schedule their mammogram.”

Watch Shannon Haugen’s Story

Talk to your primary care provider about routine health screenings, including breast screenings. Find a mammogram location near you.