A CEM-guided breast biopsy, also called contrast-enhanced mammogram (CEM)-guided core needle biopsy, is a minimally invasive outpatient procedure. During the procedure, a breast radiologist uses a contrast-enhanced mammogram to guide a needle into a specific area of breast tissue to obtain a small sample for testing.
UPMC breast imaging experts provide advanced diagnostic care. Our leading-edge imaging technology, combined with our minimally invasive needle biopsy techniques, enables our breast biopsy teams to deliver fast and accurate results.
A CEM-guided breast biopsy, also called contrast-enhanced mammogram (CEM)-guided core needle biopsy, is a minimally invasive outpatient procedure. During the procedure, a breast radiologist uses a contrast-enhanced mammogram to guide a needle into a specific area of breast tissue to obtain a small sample for testing.
Your doctor may suggest a CEM-guided breast biopsy for suspicious areas of the breast that are only visible on other contrast-enhanced breast imaging studies, including MRI or CEM.
When compared to surgical breast biopsy, CEM-guided breast biopsy offers benefits, including:
Like all medical procedures, CEM-guided breast biopsy has some minor risks, including:
Your doctor will explain the procedure to you and answer your questions. To prepare for the procedure, you should:
On the day of your procedure, arrive one hour before your scheduled procedure time. Be sure to bring your photo ID, health insurance card(s), and a written order/prescription for the biopsy from your referring provider.
You should wear a two-piece outfit (shirt and pants/shorts) and bring a sports bra, if you have one. Wearing a supportive bra after your procedure can minimize breast movement and discomfort.
You should be able to drive home and resume normal activities right away.
CEM-guided breast biopsies take about 15 minutes. However, you should plan to be at the breast center for up to two hours.
You will receive an injection of numbing medication that will cause a burning sensation for about 15 seconds. You should feel mild pressure during your biopsy due to breast compression, but you should not feel any pain.
There are several parts to a CEM-guided breast biopsy procedure, including:
When you arrive at the biopsy center, a member of your care team will place an IV in your arm. You will receive an injection of a contrast agent through your IV to highlight the abnormal area in your breast. The contrast may cause a warm sensation, and you may feel like you need to urinate. This is normal and will go away in a few minutes. You may briefly notice a metallic taste in your mouth. It takes about two minutes for the dye to travel through your bloodstream and highlight suspicious areas in your breast.
Your breast will be compressed as it is during a standard mammogram, with slightly less pressure. Your care team will take mammogram images to identify the area of concern. A small paddle with a central opening is used to allow your radiologist to access the area of concern in your breast. Your breast will stay compressed during the entire procedure, and it is important to remain still.
After cleaning your skin, a member of your care team will inject a numbing medication into the area to be biopsied. You will feel some burning for about 15 seconds while the numbing medication is given. You may feel some pressure during your biopsy, but you should not feel any pain.
Your radiologist will make a small incision in your skin and insert the biopsy needle using mammography guidance. After the needle is in the correct position, your radiologist will take several small tissue samples for analysis in the lab. You will feel some vibration while we take the tissue samples. After tissue sampling, an x-ray image is taken of the specimen to confirm that samples were taken from the correct area.
Your radiologist will place a small titanium clip at your biopsy site to mark the area for future breast imaging or surgery. The clip does not set off metal detectors and is MRI-compatible.
Our staff will put pressure on your incision site for about 10 minutes to help reduce potential bleeding. A member of your care team will cover your incision with wound-closure strips and a bandage. The wound-closure strips should stay on until they fall off naturally, usually after about a week. You will also have a mammogram to verify that the biopsy clip is properly positioned.
You should be able to drive home after your breast biopsy procedure and resume your normal activities within a few hours. You may notice some pain, discomfort, or bruising that should improve within 7-10 days.
During your recovery, you should:
Call your doctor right away if you notice signs of infection or complications including:
After your CEM-guided breast biopsy, our team will make sure you receive the follow-up care you need.
Our experts understand that waiting for biopsy results can be stressful. It is important to remember that most breast biopsies turn out to be benign (noncancerous). A nurse will call, or make sure your health care provider has called, to inform you of your biopsy results as soon as your results are received from the pathology department. This usually takes 2-4 business days after your biopsy. Your results will be immediately available in your patient portal as soon as they are ready.
About 20% (1 in 5) CEM-guided breast biopsies detect cancer.
If your biopsy indicates cancer, you will be referred to a team of UPMC breast cancer experts for treatment. UPMC is nationally recognized and offers the most advanced treatment options available, including surgery, radiation therapy, chemotherapy, and hormonal therapies, as well as complementary therapies. Physicians specially trained in the management of breast cancer will review your case with you and develop a personalized treatment plan. Our supportive care team can help you and your loved ones manage the many emotions and questions that may arise throughout the diagnosis, treatment, and recovery process.
Your pathologist may report a variety of atypical findings on a core needle biopsy. If you receive an atypical biopsy result, your doctor may recommend that you schedule an appointment at our high-risk breast cancer clinic to discuss risk-reducing strategies.
Atypical ductal hyperplasia (ADH) is a pre-cancerous condition that occurs when some, but not all, changes resemble breast cancer. If ADH is found, your doctor may recommend surgical excision of a small amount of additional tissue because there is a 20-35% chance that cancer could be present.
Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are not cancer, but are markers of increased risk of developing cancer in either breast. If you have ALH, your doctor may recommend a six-month follow-up or surgical excision. For LCIS, your doctor may recommend a breast MRI and/or surgical excision of additional tissue at that spot.
Your radiologist will need to determine if your imaging results match with the pathology results. Most of the time, you can return to routine screening after a benign result on core needle biopsy. However, a repeat biopsy or surgical excision may be recommended in certain cases.
When you choose UPMC for CEM-guided breast biopsy, you will receive:
By UPMC Editorial Staff. Last reviewed on 2025-08-28.
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