Authors: (including presenting author): :
Chin LHQ(1), Mok KYN(1), Lau HT(1), Ho G(1), Wong WC(1), Wong L(1), Lam PYT(1)
Affiliation: :
(1)Department of Radiology, Queen Mary Hospital
Keyword 1: :
contrast-enhanced mammography (CEM)
Keyword 2: :
CEM-guided breast biopsy
Keyword 3: :
vacuum-assisted breast biopsy (VABB)
Keyword 4: :
MRI-guided breast biopsy
Keyword 5: :
Workflow efficiency
Keyword 6: :
Cost-effectiveness
Introduction: :
Contrast-enhanced mammography (CEM)–guided breast biopsy is an emerging alternative to MRI-guided biopsy, offering streamlined workflow and lower cost. To meet rising demand for image-guided breast biopsies under constrained MRI capacity, Queen Mary Hospital (QMH) implemented Hong Kong Hospital Authority’s first CEM-guided biopsy service in April 2025. This innovation aligns with the “Better Manage Growing Demands II” theme by improving efficiency, reducing patient waiting times, and reallocating MRI resources to higher-priority indications.
Objectives: :
The project aimed to establish the feasibility and safety of CEM-guided breast biopsy as a practical alternative to MRI-guided biopsy, while shortening procedure time, improving patient tolerance, and reducing referral-to-biopsy waiting time. A further objective was to increase MRI capacity for other urgent and elective examinations by diverting eligible cases to CEM guidance.
Methodology: :
The service was commissioned in early 2025, with development of clinical protocols, multidisciplinary staff training for radiologists, radiographers, and nurses, and equipment calibration. Consecutive referrals originally scheduled for MRI-guided breast biopsy underwent feasibility screening for CEM-guided biopsy based on lesion visibility on CEM, lesion location and accessibility, and patient suitability for iodinated contrast. Procedures were performed using CEM for lesion localization with stereotactic-guided vacuum-assisted biopsy, and we recorded procedural duration, patient-reported tolerance, and immediate procedural outcomes. We compared CEM-guided biopsy procedure times and referral-to-procedure waiting times with historical metrics for MRI-guided biopsy, and we tracked the number of MRI slots released by diverting cases. The initial data set comprised the first six CEM-guided biopsies performed since April 2025.
Result & Outcome: :
Queen Mary Hospital successfully performed six CEM-guided biopsies to date, establishing the first such service within the Hospital Authority and rest of Hong Kong. The mean CEM-guided biopsy time was 12–13 minutes per case compared with 45–90+ minutes for MRI-guided biopsy, yielding an approximately three- to seven-fold reduction in time per procedure. Patients reported markedly better tolerance with CEM, attributable to shorter in-scanner time and less claustrophobia and anxiety than with MRI. Waiting time decreased from 3–4 months for MRI-guided biopsy to 2–3 weeks for CEM-guided biopsy, expediting preoperative decision-making, particularly for newly diagnosed breast cancer patients with MRI-detected suspected multifocal disease requiring confirmation before surgery. At a system level, diversion of eligible cases freed MRI appointment slots for other urgent and elective indications, thereby improving overall MRI service capacity. All procedures were completed as planned with successful lesion targeting, and no immediate major complications were observed in this initial series. In conclusion, CEM-guided breast biopsy is a faster, simpler, and cheaper alternative to MRI-guided biopsy, enabling substantial reductions in procedure time and waiting time while improving patient tolerance and freeing MRI capacity. Early experience at QMH supports broader adoption and scale-up to meet growing demand.
