Barriers to Implementation of Contrast-Enhanced Mammography in Clinical Practice: AJR Expert Panel Narrative Review

Accumulating evidence shows that contrast-enhanced mammography (CEM) has higher diagnostic performance than digital mammography and ultrasound, and comparable diagnostic performance as MRI, for various indications. CEM also offers certain practical advantages for patients. Nevertheless, the clinical implementation of CEM has been limited due to a range of factors. This AJR Expert Panel Narrative Review explores such factors hindering CEM implementation. These include: risks of iodinated contrast media, increased radiation exposure, indications for which CEM is not the preferred test or for which further evidence is needed, workflow adjustments when performing CEM examinations, incomplete availability of CEM-guided biopsy systems, and reimbursement challenges. Considerations that currently or are expected to mitigate these factors are also highlighted.