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Reichman M, Chen X, Lee A, Losner J, Thomas C, Katzen J. Yield of MR-directed US for MRI-detected breast findings: how often can we avoid MR biopsy? Clin Imaging 2024; 111:110174. [PMID: 38781615 DOI: 10.1016/j.clinimag.2024.110174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To evaluate the yield of MR-directed ultrasound for MRI detected breast findings. METHODS This retrospective study included 857 consecutive patients who had a breast MRI between January 2017-December 2020 and received a BI-RADS 4 assessment. Only exams recommended for MR-directed ultrasound were included in the study, yielding 765 patients. Findings were characterized by presence or absence of a sonographic correlate. Utilizing the electronic medical record, for those with a sonographic correlate, the size, location, and morphology were noted. Imaging guided (Ultrasound and MRI) pathology results as well as excisional pathology results were recorded. A multivariable logistical regression analysis was used to investigate the clinical utility of MR-directed ultrasound. RESULTS There were 1262 MRI-detected BI-RADS category 4 findings in 765 patients. Of the 1262 findings, MR-directed ultrasound was performed on 852 (68 %). Of these, 291/852 (34 %) had an ultrasound correlate, including 143/291 (49 %) benign lesions, 81/291 (28 %) malignant lesions, 16/291 (5 %) with high-risk pathology and 51/291 (18 %) unknown due to lost to follow-up. Of those findings with ultrasound correlates, 173/291 (59 %) represented masses, 69/291 (24 %) were regions of non-mass enhancement, 22/291 (7.6 %) were foci and 27/291 (9.3 %) fell into the category of other which included lymph node, cysts, and scar tissue. Masses were significantly more likely to be identified on MR-directed ultrasound (p < 0.0001) compared to foci. CONCLUSION The yield of MR-directed ultrasound is significantly higher for masses, than foci and non-mass enhancement, which should be taken into consideration when recommending an MR-directed ultrasound.
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Affiliation(s)
- Melissa Reichman
- Weill Cornell Medicine at New York-Presbyterian Hospital, 525 East 68(th) Street, New York, NY 10065, United States of America.
| | - Xiaoxuan Chen
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Annabel Lee
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Julia Losner
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Charlene Thomas
- Weill Cornell Medicine, Department of Population Health Sciences, United States of America.
| | - Janine Katzen
- Weill Cornell Medicine at New York-Presbyterian Hospital, 525 East 68(th) Street, New York, NY 10065, United States of America.
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Izumori A, Kokubu Y. Ultrasound diagnosis of non-mass MRI-detected lesions. J Med Ultrason (2001) 2023; 50:351-360. [PMID: 37119448 PMCID: PMC10354149 DOI: 10.1007/s10396-023-01306-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/13/2023] [Indexed: 05/01/2023]
Abstract
Magnetic resonance imaging (MRI)-detected lesions are often category 2 or 3 lesions on initial ultrasound examination. In addition, in the case of new non-mass lesions detected on MRI, one would expect to find lesions with ductal dilatation with minimal secretory accumulation, single short lesions with ductal dilatation, cyst-like lesions less than 5 mm in size, mammary gland-like lesions less than 8 mm in size, and very indistinct lesions. Detection is expected to be even more difficult. Currently, there are no clear uniform criteria for the indication of second-look ultrasonography (US) for MRI-detected lesions, so it is not possible to make a general comparison, but recent studies have indicated that the ratio of mass to non-mass MRI-detected lesions is 7:3. And it has been pointed out that the percentage of malignancy is about 30% for each. Before about 2012, the US detection rate was about 70%, and MRI-guided biopsies of undetected lesions showed a small percentage of malignant lesions. Therefore, some observers believe that lesions not detected on US should be followed up, while others believe that MRI-guided biopsy should be performed. Recently, however, the use of surrounding anatomical structures as landmarks for second-look US has increased the detection rate to as high as 87-99%, and the percentage of malignancy remains the same. In addition, recent surveillance of high-risk breast cancer requires careful management of MRI-detected lesions. In this review, we will discuss the literature on MRI-detected lesions and describe ultrasound techniques to accurately detect small lesions and reliably reveal pale lesions based on their structural differences from their surroundings.
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Affiliation(s)
- Ayumi Izumori
- Department of Breast Surgery, Takamatsu Heiwa Hospital, Takamatsu, Japan.
| | - Yumi Kokubu
- Department of Ultrasound/IVR Diagnostic Imaging Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Nguyen DL, Myers KS, Oluyemi E, Mullen LA, Panigrahi B, Rossi J, Ambinder EB. BI-RADS 3 Assessment on MRI: A Lesion-Based Review for Breast Radiologists. JOURNAL OF BREAST IMAGING 2022; 4:460-473. [DOI: 10.1093/jbi/wbac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 12/15/2022]
Abstract
Abstract
Unlike mammography and US, limited data exist to establish well-defined criteria for MRI findings that have a ≤2% likelihood of malignancy. Therefore, determining which findings are appropriate for a BI-RADS 3 assessment on MRI remains challenging and variable among breast radiologists. Emerging data suggest that BI-RADS 3 should be limited to baseline MRI examinations (or examinations with less than two years of prior comparisons) performed for high-risk screening and only used for masses with all of the typical morphological and kinetic features suggestive of a fibroadenoma or dominant enhancing T2 hypointense foci that is distinct from background parenchymal enhancement and without suspicious kinetics. This article presents an updated discussion of BI-RADS 3 assessment (probably benign) for breast MRI using current evidence.
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Affiliation(s)
- Derek L Nguyen
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Kelly S Myers
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Eniola Oluyemi
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Lisa A Mullen
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Babita Panigrahi
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Joanna Rossi
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Emily B Ambinder
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
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Coskun Bilge A, Demir PI, Aydin H, Bostanci IE. Dynamic contrast-enhanced breast magnetic resonance imaging findings that affect the magnetic resonance-directed ultrasound correlation of non-mass enhancement lesions: a single-center retrospective study. Br J Radiol 2022; 95:20210832. [PMID: 34990263 PMCID: PMC9153717 DOI: 10.1259/bjr.20210832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Our single-center retrospective study aimed to evaluate the relationship between magnetic resonance (MR)-directed ultrasound (MDUS) detectability and MRI findings of non-mass enhancement (NME) lesions, regarding the morphologic and enhancement features, the distance from the skin and nipple, and the presence of concomitant landmarks. METHODS A total of 350 MRI-detected NME lesions that were determined between January 2015 and May 2019 and subsequently underwent MDUS were analyzed. The MRI findings, biopsy results, and follow-up outcomes of lesions were recorded. The correlation between the MRI findings of the lesions and MDUS detectability was analyzed. RESULTS 114 (32.6%) of the 350 lesions had a counterpart in the MDUS. Respectively, 66 (37.9%), 38 (43.2%) and 59 (38.3%) of the lesions detected in MDUS were larger than 20 mm in size, with a distance of less than 20 mm to the nipple and 15 mm to the skin. The lesion size and lesion distance to the nipple and skin were significantly associated with a ultrasound correlate (p < 0.05). The MDUS detection rate was significantly higher in NME lesions with MR findings including diffuse distribution (p < 0.001), clustered-ring enhancement pattern (p < 0.001), washout kinetic curve (p = 0.006), and MR-BIRADS category 5 (p < 0.001). Multivariate logistic regression showed that only the clustered-ring enhancement pattern was significantly associated with an MDUS correlation (p < 0.001). CONCLUSION Statistically significant correlations were found between the size, distance to the nipple and skin, distribution pattern, enhancement pattern and kinetic curve of the NME lesions on MRI and ultrasound detectability. ADVANCES IN KNOWLEDGE We found that clustered-ring enhancement patterns were significantly more frequent in MR-directed ultrasound detectable lesions.
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Affiliation(s)
- Almila Coskun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Pinar Ilhan Demir
- Department of Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hale Aydin
- Department of Radiology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Isil Esen Bostanci
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Xiao L, Simmons C, Khanani S. Efficacy of MRI-Directed Breast Ultrasound and Lesion Characteristics Affecting Visualization on Breast Ultrasound. Curr Probl Diagn Radiol 2022; 51:717-721. [DOI: 10.1067/j.cpradiol.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
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Recalibrating the decision for MRI-directed breast ultrasound in patients with newly diagnosed breast cancer, factors predicting sonographic success. Clin Imaging 2021; 80:391-399. [PMID: 34530358 DOI: 10.1016/j.clinimag.2021.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/13/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evaluate utilization of MRI-directed breast ultrasound (US) in patients with newly diagnosed breast cancer and refine practices to increase success of sonographic lesion detection. METHODS This retrospective single-institution review was restricted to women with breast cancer who underwent MRI from November 2006 to January 2017. Enhancing breast lesions, separate from the index tumor, recommended for MRI-directed US were assessed to see which were detected and which characteristics predicted success in detection. Univariate mixed-effects logistic modeling predicted likelihood of finding breast lesions with US, with odds ratios reported. All tests were two-sided with p < 0.05 considered significant. RESULTS A total of 275 patients underwent MRI-directed US for 361 breast lesions, of which 187 (51.8%) were found on US. Of those detected, 171 (91.4%) were masses and 16 (8.6%) were nonmass enhancement (NME), with masses 14 times more likely to be seen (p < 0.001). Size alone was not a significant predictor but achieved significance when associated with lesion type (mass size, p < 0.001). Masses with irregular shapes or margins and invasive carcinomas were more frequently detected. Patient age, internal enhancement pattern, and distribution of NME were not significant predictors in sonographic detection. A presumed sonographic correlate for NME was found for 16 (16.2%) of 99 attempted lesions. CONCLUSION As MRI access expands, utilization of MRI-directed US should be scrutinized to avoid downstream practice inefficiencies. Sonographic detection rates for NME remain low for women undergoing MRI for disease extent, with NME often better suited for MRI-guided biopsy.
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Kim Y, Jung HK, Park AY, Ko KH, Jang H. Diagnostic value of mammography for accompanying non-mass enhancement on preoperative breast MRI. Acta Radiol 2021; 63:1032-1042. [PMID: 34260322 DOI: 10.1177/02841851211030771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Successful surgical treatment for localized breast cancer can depend on accurate diagnosis for accompanying non-mass enhancement (NME) on preoperative breast magnetic resonance imaging (MRI). PURPOSE To evaluate the diagnostic value of mammography for accompanying NME adjacent to index cancer on preoperative breast MRI. MATERIAL AND METHODS Among 569 consecutive patients who underwent preoperative breast MRI from January 2016 to August 2018 for ultrasound-guided biopsy-proven breast cancer, 471 patients who underwent initial mammography and subsequent surgery were finally included. Two radiologists retrospectively reviewed preoperative MRI findings of the 471 patients and detected accompanying NME adjacent to index cancer. MRI, mammography, and histopathology findings of the accompanying NME were evaluated using Pearson's chi-square test, Mann-Whitney U test, and logistic regression analysis. The area under the receiver operating characteristic curve (AUC) of MRI and combined MRI and mammography was calculated in differentiating benign from malignant accompanying NME. The reference standard was surgical pathologic findings. RESULTS MRI revealed 93 accompanying NME lesions in 92 (19.5%) of the 471 patients, showing 55 (59.1%) malignant and 38 (40.9%) benign lesions. On multivariate analysis, malignant NME lesions were more associated with mammography-positive findings (P = 0.000), clumped or clustered ring internal enhancement (P = 0.015), and extensive intraductal component presence of index tumor (P = 0.007) compared with benign lesions. The AUC increased after correlation with mammography showing 0.649 (95% confidence interval [CI] 0.533-0.765) for MRI and 0.833 (95% CI 0.747-0.919) for combined MRI and mammography. CONCLUSION Mammography is valuable in predicting malignancy for accompanying NME on preoperative breast MRI.
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Affiliation(s)
- Yunju Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Division of Radiology, Center for Breast Cancer, National Cancer Center, Madu 1-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ah Young Park
- Department of Radiology, CHA Bundang Medical Center, CHA University, Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyung Hee Ko
- Department of Radiology, CHA Bundang Medical Center, CHA University, Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyunkyung Jang
- Department of Radiology, CHA Kangnam Medical Center, CHA University, Yeoksam-dong, Gangnam-gu, Seoul, Republic of Korea
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Utility of Targeted Ultrasound to Predict Malignancy Among Lesions Detected on Contrast-Enhanced Digital Mammography. AJR Am J Roentgenol 2020; 217:595-604. [PMID: 33025811 DOI: 10.2214/ajr.20.24368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Targeted ultrasound (US) can be performed to characterize and potentially biopsy areas of enhancement detected on contrast-enhanced mammography (CEM). OBJECTIVE. The purpose of this study was to assess the utility of targeted US in predicting malignancy of lesions with indeterminate or suspicious enhancement on CEM. METHODS. One thousand consecutive CEM examinations with same-day targeted breast US at one institution between October 2013 and May 2018 were retrospectively reviewed. All patients with indeterminate or suspicious enhancement detected on CEM that underwent US evaluation were included. Patients with palpable or symptomatic lesions, those with suspicious findings on low-energy mammograms or images obtained with another modality, and those with less than 1 year of follow-up were excluded. Medical records, imaging, and pathology data were reviewed. Histopathologic analysis was used as the reference standard for biopsied lesions, and follow-up imaging was used for unbiopsied lesions. Associations between pathologic diagnosis, presence of a US correlate, and lesion characteristics were assessed by Fisher exact, chi-square, and Wilcox-on rank sum tests. RESULTS. Among 153 enhancing lesions detected on CEM in 144 patients, 47 (31%) had a US correlate. The frequency of a correlate between CEM and US was significantly higher among enhancing masses (28/43 [65%]) than among lesions exhibiting nonmass enhancement (19/110 [17%]) (p < .001). The likelihood of malignancy was significantly greater among lesions with a US correlate (12/47 [26%]) than among those without a US correlate (11/106 [10%]) (p = .03), and among mass lesions (11/43 [26%]) than among nonmass lesions (12/110 [11%]) (p = .04). The PPV of US-guided biopsy after CEM-directed US was 32%. CONCLUSION. Enhancing CEM-detected lesions that have a US correlate are more likely to be malignant and can be evaluated with US-guided biopsy to obviate additional breast MRI. CLINICAL IMPACT. CEM-directed US of enhancing lesions is useful given that lesions with a US correlate are more likely to be malignant and can be used as targets for US-guided biopsy until a CEM biopsy system becomes commercially available.
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Kwon BR, Chang JM, Kim SY, Lee SH, Shin SU, Yi A, Cho N, Moon WK. Utility and Diagnostic Performance of Automated Breast Ultrasound System in Evaluating Pure Non-Mass Enhancement on Breast Magnetic Resonance Imaging. Korean J Radiol 2020; 21:1210-1219. [PMID: 32729267 PMCID: PMC7462763 DOI: 10.3348/kjr.2019.0881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/11/2020] [Accepted: 03/29/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the utility and diagnostic performance of automated breast ultrasound system (ABUS) with that of hand-held ultrasound (HHUS) in evaluating pure non-mass enhancement (NME) lesions on breast magnetic resonance imaging (MRI). Materials and Methods One hundred twenty-six consecutive MRI-visible pure NME lesions of 122 patients with breast cancer were assessed from April 2016 to March 2017. Two radiologists reviewed the preoperative breast MRI, ABUS, and HHUS images along with mammography (MG) findings. The NME correlation rate and diagnostic performance of ABUS were compared with that of HHUS, and the imaging features associated with ABUS visibility were analyzed. Results Among 126 pure NME lesions, 100 (79.4%) were malignant and 26 (20.6%) were benign. The overall correlation rate was 87.3% (110/126) in ABUS and 92.9% (117/126) in HHUS. The sensitivity and specificity were 87% and 50% for ABUS and 92% and 42.3% for HHUS, respectively, with no significant differences (p = 0.180 and 0.727, respectively). Malignant NME was more frequently visualized than benign NME lesions on ABUS (93% vs. 65.4%, p = 0.001). Significant factors associated with the visibility of ABUS were the size of NME lesions on MRI (p < 0.001), their distribution pattern (p < 0.001), and microcalcifications on MG (p = 0.027). Conclusion ABUS evaluation of pure NME lesions on MRI in patients with breast cancer is a useful technique with high visibility, especially in malignant lesions. The diagnostic performance of ABUS was comparable with that of conventional HHUS in evaluating NME lesions.
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Affiliation(s)
- Bo Ra Kwon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Soo Yeon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Ui Shin
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Ann Yi
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kolta M, Clauser P, Kapetas P, Bernathova M, Pinker K, Helbich TH, Baltzer PAT. Can second-look ultrasound downgrade MRI-detected lesions? A retrospective study. Eur J Radiol 2020; 127:108976. [PMID: 32339982 DOI: 10.1016/j.ejrad.2020.108976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine whether MRI-detected suspicious (BIRADS 4 & 5) breast lesions can be downgraded using second-look ultrasound (SLU) and thus reduce unnecessarily performed breast biopsies. MATERIALS METHODS A retrospective single-center review of consecutive patients, who underwent breast MRI studies during a 12-month time period was performed. 94 patients with 103 lesions undergoing SLU of incidentally detected MRI BI-RADS 4&5 lesions which were not identified on previous ultrasound were included in the study. The SLU detection rate and SLU features of the lesions were assessed. Histology (91/103) or two year follow up (n = 12) were defined as the reference standard for lesion diagnosis. RESULTS 57 (55.3 %) of the 103 lesions were identified on SLU. 17 of the identified lesions were malignant (29.8 %). Lesions detected on ultrasound presented on MRI as masses in 66.7 % (38/57) and non-mass in 33.3 % (19/57). Our findings showed that it is possible to distinguish between malignant and benign lesions with SLU. The results were significant (p < 0.05) for the following morphological features: shape, orientation, margins, architectural distortion, hyperechoic rim/ edema. All lesions classified as SLU BI-RADS 2 in our study were benign and thus, 30 % of all unnecessary biopsies could potentially have been avoided. Including SLU BI-RADS 3 lesions, this rate increased to 60 %, while yielding one (of 17, 5.8 %) false negative result. All three BI-RADS 5 lesions detected by SLU presented as malignant on ultrasound. CONCLUSION SLU can potentially downgrade incidental MRI BIRADS 4 lesions. This may reduce the number of unnecessarily performed biopsies by 30-60 %, thus simplifying patient management.
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Affiliation(s)
- Michael Kolta
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria; Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria.
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Chikarmane S, Jin B, Giess C. Accuracy of MRI-directed ultrasound and subsequent ultrasound-guided biopsy for suspicious breast MRI findings. Clin Radiol 2020; 75:185-193. [DOI: 10.1016/j.crad.2019.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 11/26/2022]
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12
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Yalnız C, Rosenblat J, Spak D, Wei W, Scoggins M, Le-Petross C, Dryden MJ, Adrada B, Doğan BE. Association of Retrospective Peer Review and Positive Predictive Value of Magnetic Resonance Imaging-Guided Vacuum-Assisted Needle Biopsies of Breast. Eur J Breast Health 2019; 15:229-234. [PMID: 31620681 DOI: 10.5152/ejbh.2019.5002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/30/2019] [Indexed: 12/17/2022]
Abstract
Objective To evaluate the association between retrospective peer review of breast magnetic resonance imaging-guided vacuum-assisted needle biopsies and positive predictive value of subsequent magnetic resonance imaging-guided biopsies. Materials and Methods In January, 2015, a weekly conference was initiated in our institution to evaluate all breast magnetic resonance imaging-guided vacuum-assisted needle biopsies performed over January 1, 2014-December 31, 2015. During this weekly conferences, breast dynamic contrast-enhanced magnetic resonance imaging findings of 6 anonymized cases were discussed and then the faculty voted on whether they agree with the biopsy indication, accurate sampling and radiology-pathology correlation. We retrospectively reviewed and compared the magnetic resonance imaging indication, benign or malignant pathology rates, lesion types and the positive predictive value of magnetic resonance imaging-guided vacuum-assisted needle biopsy in the years before and after initiating this group peer review. Results The number of dynamic contrast-enhanced magnetic resonance imaging and magnetic resonance imaging-guided vacuum-assisted needle biopsies before and after initiating the review were 1447 vs 1596 (p=0.0002), and 253 (17.5%) vs 203 (12.7%) (p=0.04), respectively. There was a significant decrease in the number of benign biopsies in 2015 (n=104) compared to 2014 (n=154, p=0.04). The positive predictive value of magnetic resonance imaging-guided biopsy significantly increased after group review was implemented (Positive predictive value in 2014=%39.1 and positive predictive value in 2015=%48.8) (p=0.03), although the indications (p=0.49), history of breast cancer (p=0.14), biopsied magnetic resonance imaging lesion types (p=0.53) were not different. Less surgical excision was performed on magnetic resonance imaging-guided vacuum-assisted needle biopsy identified high-risk lesions in 2015 (p=0.25). Conclusion Our study showed an association between retrospective peer review of past biopsies and increased positive predictive value of magnetic resonance imaging-guided vacuum-assisted needle biopsies in our institution.
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Affiliation(s)
- Ceren Yalnız
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Juliana Rosenblat
- Department of Diagnostic Radiology, Memorial Healthcare System, Hollywood, FL, USA
| | - David Spak
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Wei Wei
- Taussig Cancer Institute Cleveland Clinic, Biostatistics, Cleveland, OH, USA
| | - Marion Scoggins
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Carisa Le-Petross
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Mark J Dryden
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Beatriz Adrada
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Başak E Doğan
- Department of Radiology, Division of Breast Imaging, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Izumori A, Kokubu Y, Sato K, Gomi N, Morizono H, Sakai T, Horii R, Akiyama F, Iwase T, Ohno S. Usefulness of second-look ultrasonography using anatomical breast structures as indicators for magnetic resonance imaging-detected breast abnormalities. Breast Cancer 2019; 27:129-139. [PMID: 31407151 PMCID: PMC6954142 DOI: 10.1007/s12282-019-01003-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/07/2019] [Indexed: 11/29/2022]
Abstract
Background Second-look ultrasonography (US) is commonly performed for breast lesions detected using magnetic resonance imaging (MRI), but the identification rate of these lesions remains low. We investigated if US methods using anatomical breast structures can improve the lesion identification rate of MR-detected lesions and evaluated the diagnostic performance of fine-needle aspiration cytology (FNAC) of the second-look US using the above-mentioned method. Methods We retrospectively assessed 235 breast lesions (hereinafter, “targets”) subjected to second-look US following MRI between January 2013 and September 2015. US was employed using the conventional methods, and this assessment measured the positional relationships of lesions with regard to surrounding anatomical breast structures (glandular pattern, Cooper’s ligaments, adipose morphology, and vascular routes). Associations were assessed among the following variables: the MRI findings, target size, identification rate, and main US indicators that led to identifying the target; FNAC results and MRI findings; MRI findings and histopathological findings; and FNAC results and histopathological findings. Moreover, the sensitivity and specificity of FNAC were determined. Results The identification rate was 99%. The main US indicators leading to identification were a glandular pattern (28–30% of lesions) and other breast structures (~ 25% of lesions). FNAC was performed for 232 targets with the following results: sensitivity of 85.7%, specificity of 91.6%, PPV of 94.1%, NPV of 92.9%, false-negative rate of 14.3%, false-positive rate of 2.1%, and accuracy of 89.7%. Conclusions Second-look US using anatomical breast structures as indicators and US-guided FNAC are useful for refining the diagnosis of suspicious breast lesions detected using MRI.
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Affiliation(s)
- Ayumi Izumori
- Department of Breast Surgery, Takamatsu Heiwa Hospital, Takamatsu, Japan.
| | - Yumi Kokubu
- Department of Diagnostic Imaging, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Ultrasound, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuko Sato
- Department of Ultrasound, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoya Gomi
- Department of Diagnostic Imaging, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetomo Morizono
- Department of Cytology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takehiko Sakai
- Department of Cytology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Horii
- Department of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Futoshi Akiyama
- Department of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Bumberger A, Clauser P, Kolta M, Kapetas P, Bernathova M, Helbich TH, Pinker K, Baltzer PA. Can we predict lesion detection rates in second-look ultrasound of MRI-detected breast lesions? A systematic analysis. Eur J Radiol 2019; 113:96-100. [PMID: 30927966 DOI: 10.1016/j.ejrad.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 01/22/2019] [Accepted: 02/09/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To predict detection rates (DR) in second-look ultrasound of MRI-detected breast lesions by systematically combining clinical and anthropomorphic features. METHODS A total of 104 suspicious breast-lesions, that were initially detected on breast MRI and underwent subsequent SLU from January 2013 through December 2013, were evaluated in this retrospective analysis. All images were reviewed by an experienced radiologist for this study. Both anthropomorphic, spatial and BI-RADS lesion features were recorded. Uni- and multivariate Classification and Regression Trees (CRT) statistics were used to predict SLU DR by these features. RESULTS Among 104 MRI-detected lesions, 58 (55.8%) showed a correlate on SLU. In univariate analysis, homogeneous fatty or dense fibro-glandular-tissue-composition (FGT) as assessed by ultrasound, segmental non-mass-distribution pattern and small breast size as assessed by MRI were significantly associated with higher DR on SLU. The remaining BI-RADS features did not significantly affect SLU DR according to our data. The predictive model could stratify the likelihood of SLU correlates as high, intermediate and low according to FGT, lesion type, size and position. CONCLUSIONS By systematically combining the features FGT, lesion type, size and position, we could predict SLU DR of MRI-detected breast lesions. This may help to decide the preferable method for lesion biopsy or follow-up in clinical practice.
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Affiliation(s)
- Alexander Bumberger
- Department of Biomedical Imaging and Image-guided Therapy,Medical University of Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy,Medical University of Vienna, Austria
| | - Michael Kolta
- Department of Biomedical Imaging and Image-guided Therapy,Medical University of Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy,Medical University of Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy,Medical University of Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy,Medical University of Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy,Medical University of Vienna, Austria
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy,Medical University of Vienna, Austria.
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15
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Six-year prospective evaluation of second-look US with volume navigation for MRI-detected additional breast lesions. Eur Radiol 2018; 29:1799-1808. [DOI: 10.1007/s00330-018-5765-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/06/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
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Volume Navigation Technique for Ultrasound-Guided Biopsy of Breast Lesions Detected Only at MRI. AJR Am J Roentgenol 2017; 208:1400-1409. [PMID: 28267361 DOI: 10.2214/ajr.16.16808] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study is to assess the utility of a volume navigation technique (VNT) for ultrasound-guided biopsy of MRI-detected, but sonographically ambiguous or occult, breast lesions. SUBJECTS AND METHODS Within a recruitment period of 13 months (January 1, 2014, through February 1, 2015), 22 patients with 26 BI-RADS category 4 or 5 lesions that were detected at MRI but missed at second-look ultrasound were reimaged using a rapid sequence and a flexible body coil in a 3-T MRI scanner. Patients were supine, with three skin markers placed on the breasts. MRI volume data were coregistered to real-time ultrasound in a dedicated platform, and MRI-detected lesions (six masses, 11 nonmass enhancements, eight foci, and one architectural distortion) were sought using VNT-guided ultrasound. Five needle biopsy specimens were obtained either from each sonographically detected lesion (n = 11) or from VNT-guided sonographically localized breast volume corresponding to the MRI-detected, but still ultrasound-occult, lesions (n = 15). RESULTS Histopathologic analysis revealed 18 benign and six malignant lesions. The remaining two lesions, both of which appeared as masses at MRI, were high risk and were upgraded to carcinoma after excisional biopsy. All malignant lesions underwent curative surgery; the final histopathologic diagnoses remained unchanged. Of the six malignant lesions, one was a mass, three were nonmass enhancements, and two were enhancing foci at MRI. Three malignant lesions were occult at ultrasound, and three were discerned as subtle hypoechoic changes. No benign lesion was sonographically visualized as a mass, and none progressed, with 56% disappearing at MRI performed during the follow-up period (mean, 14 months). CONCLUSION Coregistration of MRI and real-time ultrasound enables sonographic localization of breast lesions detected at MRI only. VNT is a feasible alternative to MRI-guided biopsy of ultrasound-occult breast lesions.
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17
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Newburg AR, Chhor CM, Young Lin LL, Heller SL, Gillman J, Toth HK, Moy L. Magnetic Resonance Imaging-Directed Ultrasound Imaging of Non-Mass Enhancement in the Breast: Outcomes and Frequency of Malignancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:493-504. [PMID: 28108994 DOI: 10.7863/ultra.16.03001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study was performed to determine the frequency, predictors, and outcomes of ultrasound (US) correlates for non-mass enhancement. METHODS From January 2005 to December 2011, a retrospective review of 5837 consecutive breast magnetic resonance imaging examinations at our institution identified 918 non-mass enhancing lesions for which follow-up or biopsy was recommended. Retrospective review of the images identified 879 of 918 lesions (96%) meeting criteria for non-mass enhancement. Patient demographics, pathologic results, and the presence of an adjacent landmark were recorded. Targeted US examinations were recommended for 331 of 879 cases (38%), and 284 of 331 women (86%) underwent US evaluations. RESULTS The US correlate rate for non-mass enhancement was 23% (64 of 284). An adjacent landmark was significantly associated with a US correlate (P < .001). Biopsy was recommended for 43 of 64 correlates (67%). Ultrasound-guided biopsy was performed on 39 of 43 (91%); 7 of 39 (18%) were malignant. No correlate was seen for 220 of 284 lesions (77%). At magnetic resonance imaging-guided biopsy, 14 of 117 (12%) were malignancies. For all biopsied non-mass enhancements, the malignancy rate was 18% (55 of 308) and was significantly more prevalent in the setting of a known index cancer (P < .001), older age (P < .001), the presence of a landmark (P = .002), and larger lesion size (P = .019). CONCLUSIONS Non-mass enhancement with an adjacent landmark is more likely to have a US correlate compared to non-mass enhancement without an adjacent landmark. Non-mass enhancement in the setting of a known index cancer, older age, a landmark, and larger lesion size is more likely to be malignant. However, no statistical difference was detected in the rate of malignancy between non-mass enhancement with (18%) or without (12%) a correlate. Absence of a correlate does not obviate the need to biopsy suspicious non-mass enhancement.
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Affiliation(s)
- Adrienne R Newburg
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chloe M Chhor
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Leng Leng Young Lin
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Samantha L Heller
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Jennifer Gillman
- Department of Internal Medicine, Lenox Hill Hospital, New York, New York, USA
| | - Hildegard K Toth
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Linda Moy
- Department of Radiology, New York University School of Medicine, New York, New York, USA
- Department of Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, New York, USA
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Cheung JY, Moon JH. Follow-up design of unexpected enhancing lesions on preoperative MRI of breast cancer patients. Diagn Interv Radiol 2016; 21:16-21. [PMID: 25430525 DOI: 10.5152/dir.2014.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE We aimed to analyze the characteristics and long-term follow-up results of unexpected enhancing lesions on preoperative magnetic resonance imaging (MRI) of breast cancer patients. METHODS From August 2007 through February 2010, second-look ultrasound (SLUS) was recommended for 84 of 312 breast cancer patients having unexpected enhancing lesions on MRI. SLUS was performed for 85 unexpected enhancing lesions in 72 patients. We performed a retrospective review to determine the size, lesion type, enhancement kinetic curve, and location in relation to the index cancer. We obtained the pathologic outcome of the detected lesions and in case of a negative finding on SLUS, we performed follow-up examinations for at least two years. RESULTS Of 85 unexpected lesions, 72 (85%) were detected on SLUS. In total, 41 lesions (56.9%) were confirmed as malignant and 31 lesions (43.6%) as benign. Cancer rate was statistically higher in lesions having type III enhancement pattern, located at the same quadrant as the index cancer. However, no significant association was observed between the cancer rate and the lesion size and type. None of the 13 negative cases on SLUS developed cancer on follow-up. CONCLUSION In case of unexpected enhancing lesions on preoperative MRI of breast cancer patients, SLUS can be useful to find out the matched lesion. Lesions with type III enhancement pattern or those located at the same quadrant as the index cancer should be considered as a separate cancer. In the absence of any suspicious findings on SLUS, patient may be followed up with confidence.
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Affiliation(s)
- Joo Yeon Cheung
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Korea.
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Kim Y, Kang BJ, Kim SH, Lee EJ. Prospective Study Comparing Two Second-Look Ultrasound Techniques: Handheld Ultrasound and an Automated Breast Volume Scanner. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2103-2112. [PMID: 27503758 DOI: 10.7863/ultra.15.11076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to compare the diagnostic performance of handheld ultrasound (US) and an automated breast volume scanner (ABVS) as second-look US techniques subsequent to preoperative breast magnetic resonance imaging (MRI). METHODS We prospectively enrolled patients with breast cancer who underwent handheld US and ABVS examinations as second-look US modalities for additional suspicious lesions found via preoperative breast MRI. We reviewed each second-look US modality independently and evaluated the detection rate of each modality. We then analyzed the correlation between the detection rate and the MRI factors (size, distance, and enhancement type). RESULTS From March to September 2014, both types of second-look US examinations were performed on 40 patients with breast cancer who had 76 additional suspicious lesions detected via preoperative breast MRI. The detection rate of the ABVS was higher than that of handheld US for the second-look examination (94.7% versus 86.8%; P< .05). Among the 76 total lesions, 7 were only identified by the ABVS, 1 was only found by handheld US, and 3 were not detected by either the ABVS or handheld US. When we analyzed the correlation between the detection rate and MRI factors, the only meaningful factor was the enhancement type. The ability to detect a nonmass lesion was lower than the ability to detect a mass-type lesion (P < 0.05) for both the ABVS and handheld US. CONCLUSIONS For a second-look US examination subsequent to preoperative breast MRI in patients with breast cancer, the ABVS is a more efficient modality than handheld US for preoperative evaluations. However, both techniques have limitations in detecting nonmass lesions.
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Affiliation(s)
- Yoonsoo Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Eun Jae Lee
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
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Use of a Volume Navigation Technique for Combining Real-Time Ultrasound and Contrast-Enhanced MRI: Accuracy and Feasibility of a Novel Technique for Locating Breast Lesions. AJR Am J Roentgenol 2016; 206:217-25. [DOI: 10.2214/ajr.14.14101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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21
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Ferré R, Kao E, Mesurolle B. High-Risk Lesions Detected at Second-Look US for Breast Lesions Identified at MR Imaging. Radiology 2015; 276:615-6. [DOI: 10.1148/radiol.2015150121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Significance of incidentally detected subcentimeter enhancing lesions on preoperative breast MRI: role of second-look ultrasound in lesion detection and management. AJR Am J Roentgenol 2015; 204:W357-62. [PMID: 25714322 DOI: 10.2214/ajr.14.12948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to evaluate the clinical significance of subcentimeter enhancing lesions incidentally detected on preoperative breast MRI in patients with breast cancer and the role of second-look ultrasound in lesion detection and characterization. MATERIALS AND METHODS. From January 2010 through December 2010, 180 lesions measuring less than 10 mm incidentally detected on MRI in 108 women with second-look ultrasound examinations were included (mean patient age, 47.9 years; mean [± SD] lesion size, 5.56 ± 1.64 mm). Seventy-two (40.0%) lesions were smaller than 5 mm, and 108 (60.0%) were 5 mm or larger. Of the 180 lesions, 103 (57.2%) had been biopsied or excised by localization, and 77 (42.8%) with benign ultrasound features had been followed with ultrasound for at least 2 years. Clinical and imaging features were recorded for analysis. RESULTS. Of the 180 enhancing lesions detected on MRI, 14 (7.8%) were malignant and 166 (92.2%) were benign. The malignancy rate of lesions 5 mm or larger was higher than that for lesions smaller than 5 mm (10.2% vs 4.2%), without statistical significance (p = 0.344). The washout enhancement pattern was statistically significantly associated with malignancy (p = 0.032). Although malignant ultrasound features such as nonparallel orientation were more common in malignant lesions, most malignancies had benign features, including oval shape, parallel orientation, and circumscribed margins, with BI-RADS category 4a (n = 12; 85.8%) as the final assessment. CONCLUSION. Second-look ultrasound is a feasible method for evaluating MRI-detected subcentimeter sized lesions in preoperative assessment of patients with breast cancer. A lower threshold should be applied with consideration of MRI features in deciding whether to biopsy or excise these lesions.
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Additional findings at preoperative breast MRI: the value of second-look digital breast tomosynthesis. Eur Radiol 2015; 25:2830-9. [PMID: 25903704 DOI: 10.1007/s00330-015-3720-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US). METHODS We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; ≤10 mm or >10 mm in size; BI-RADS 3, 4, or 5. DM and DBT exams were reviewed looking for MRI AFs; data on SL-US were collected. Reference standard was histopathology or ≥12-month negative follow-up. Fisher exact test and McNemar test were used. RESULTS Eighty-four AFs were detected in 53/135 patients (39%, 95%CI 31-48%). A correlate was found for 44/84 (52%, 95%CI 41-63%) at SL-US, for 20/84 (24%, 95%CI 11-28%) at SL-DM, for 42/84 (50%, 95%CI 39-61%) at SL-DBT, for 63/84 (75%, 95%CI 64-84%) at SL-DBT, and/or SL-US, the last rate being higher than for SL-US only, overall (p < 0.001), for mass or non-mass, ≤ or >10 mm, BI-RADS 4 or 5, or malignant lesions (p < 0.031). Of 21 AFs occult at both SLs, 17 were malignant (81%, 95%CI 58-94%). CONCLUSIONS When adding SL-DBT to SL-US, AFs detection increased from 52% to 75%. MR-guided biopsy is needed for the remaining 25%. KEY POINTS • Detection rate of MRI AFs using SL-US was 52% • Adding SL-DBT, the detection rate of MRI AFs significantly increased to 75%. • Over 80% of the remaining 25% MRI AFs were malignant. • MR-guided biopsy should be used when SL-US and SL-DBT are inconclusive.
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Mariscotti G, Houssami N, Durando M, Campanino PP, Regini E, Fornari A, Bussone R, Castellano I, Sapino A, Fonio P, Gandini G. Digital Breast Tomosynthesis (DBT) to Characterize MRI-Detected Additional Lesions Unidentified at Targeted Ultrasound in Newly Diagnosed Breast Cancer Patients. Eur Radiol 2015; 25:2673-81. [PMID: 25813013 DOI: 10.1007/s00330-015-3669-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/21/2015] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Preoperative breast magnetic resonance (MR) often generates additional suspicious findings needing further investigations. Targeted breast ultrasound (US) is the standard tool to characterize MR additional lesions. The purpose of this study is to evaluate the potential role of digital breast tomosynthesis (DBT) to characterize MR detected additional findings, unidentified at targeted breast US. METHODS This prospective study included women who a) had biopsy-proven, newly diagnosed breast cancers detected at conventional 2D mammography and/or US, referred to breast MR for tumour staging; and b) had DBT if additional MR findings were not detected at targeted ('second look') US. RESULTS In 520 patients, MR identified 164 (in 114 women, 22%) additional enhancing lesions. Targeted US identified 114/164 (69.5%) of these, whereas 50/164 (30.5%) remained unidentified. DBT identified 32/50 of these cases, increasing the overall characterization of MR detected additional findings to 89.0% (146/164). Using DBT the identified lesions were significantly more likely to be malignant than benign MR-detected additional lesions (p = 0.04). CONCLUSIONS DBT improves the characterization of additional MR findings not identified at targeted breast US in preoperative breast cancer staging. KEY POINTS • Targeted US identified 114 of 164 (69.5%) additional enhancing lesions at preoperative breast MRI. • DBT identified a further 32 of the 50 lesions unidentified on targeted US. • DBT improved the characterization of additional MR findings for breast cancer staging.
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Affiliation(s)
- Giovanna Mariscotti
- Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza of Turin, Breast Imaging Service, Radiology - University of Turin, Via Genova 3, 10126, Torino, Italy,
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Hong MJ, Cha JH, Kim HH, Shin HJ, Chae EY, Shin JE, Choi WJ. Second-look ultrasonography for MRI-detected suspicious breast lesions in patients with breast cancer. Ultrasonography 2014; 34:125-32. [PMID: 25623054 PMCID: PMC4372709 DOI: 10.14366/usg.14046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the use of second-look ultrasonography (US) for investigating additional suspicious lesions detected on preoperative staging magnetic resonance imaging (MRI) for breast cancer. METHODS Between September 2008 and August 2010, 1,970 breast MRIs were performed at our medical institution for the evaluation of breast cancer before surgery. Second-look US was recommended for 135 patients with 149 suspicious lesions, following the MRI interpretation, and 108 patients with 121 lesions were included in this study. The detection rate on second-look US, according to the lesion type, diameter, and histopathological outcome, was analyzed. RESULTS Of the 121 lesions considered in this study, 97 (80.2%) were diagnosed on MRI as masses and 24 (19.8%) as non-mass-like lesions; 105 lesions (86.8%) were correlated and 16 (13.2%) were not correlated with the findings of second-look US. Of the 105 correlated lesions, 29 (27.6%) were proven to be malignant and 76 (72.4%) were benign. Although a greater number of large malignant lesions were correlated on second-look US than small benign lesions, there was no statistically significant difference according to lesion diameter or type, as seen on MRI or pathology. CONCLUSION We have concluded that second-look US is a useful diagnostic tool for lesions incidentally detected on breast MRI, as in this study, it could identify 86.8% of the MRI-detected breast lesions.
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Affiliation(s)
- Min Ji Hong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Eun Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea ; Department of Radiology, Gangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Plecha DM, Pham RM, Klein N, Coffey A, Sattar A, Marshall H. Addition of Shear-Wave Elastography during Second-Look MR Imaging–directed Breast US: Effect on Lesion Detection and Biopsy Targeting. Radiology 2014; 272:657-64. [DOI: 10.1148/radiol.14132491] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Spick C, Baltzer PAT. Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology 2014; 273:401-9. [PMID: 25119022 DOI: 10.1148/radiol.14140474] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the diagnostic utility of second-look ultrasonography (US) in the assessment of lesions identified at breast magnetic resonance (MR) imaging. MATERIALS AND METHODS A systematic review of the PubMed database for articles published up to January 6, 2013, was performed by using predefined search terms applied in a standardized manner. Second-look US studies for the assessment of breast lesions identified at MR imaging were eligible for this meta-analysis. Two independent reviewers performed the literature review and data extraction. Eligible studies presented data on the number of lesions examined and the number of lesions detected at second-look US. The reference standard for lesion diagnosis was either histopathologic or follow-up examination. Sources of bias were assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies 2 , tool. Statistical analysis included data pooling, heterogeneity testing, and meta-regression. RESULTS Seventeen studies that included benign and malignant lesions met the inclusion criteria. The general lesion detection rate at second-look US was very heterogeneous and ranged between 22.6% and 82.1% (pooled rate, 57.5% [1266 of 2201]; 95% confidence interval [ CI confidence interval ]: 50.0%, 64.1% [random-effects model]; I(2) = 90.9%; P < .0001). The highest second-look US detection rates were observed for mass lesions (as opposed to nonmass lesions) and malignant (vs benign) lesions (P < .001 for both). Pooled positive and negative predictive values (positive or negative second-look US correlates of MR imaging-detected malignant or benign lesions) were calculated as 30.7% (95% CI confidence interval : 25.3%, 36.4%; I(2) = 75.4%; P < .0001) and 87.8% (95% CI confidence interval : 82.0%, 92.7%; I(2) = 82.1%; P < .0001), respectively, by using random-effects models. CONCLUSION The results of this study demonstrated variable utility of second-look US in MR imaging-detected lesions, as lesion detection rates were very heterogeneous. Subgroup analysis showed that malignant and mass lesions were more likely to be detected at second-look US. Furthermore, malignancy was not excluded if a lesion was not detected at second-look US.
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Affiliation(s)
- Claudio Spick
- From the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Real-time MRI navigated US: Role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US. Eur J Radiol 2014; 83:942-950. [DOI: 10.1016/j.ejrad.2014.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/24/2014] [Accepted: 03/01/2014] [Indexed: 11/21/2022]
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Park VY, Kim MJ, Kim EK, Moon HJ. Second-look US: how to find breast lesions with a suspicious MR imaging appearance. Radiographics 2014; 33:1361-75. [PMID: 24025929 DOI: 10.1148/rg.335125109] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Breast magnetic resonance (MR) imaging has high sensitivity in breast cancer diagnosis. The probability of malignancy for additional detected lesions is higher in patients with breast cancer than in the population without malignancy, which is why biopsy or further study should be considered for additional detected lesions. Because of the shortcomings of MR imaging-guided biopsy, second-look ultrasonography (US) may be the preferred next step. Detecting target lesions at second-look US and correlating lesions between the two modalities may be challenging. Using axial MR imaging to localize the lesion with respect to the nipple and the lesion-to-nipple distance can narrow the scan range at US. Evaluating the lesion's location relative to the mammary zones and surrounding tissues, as well as noting its depth, characteristics, and nearby landmarks, will aid in lesion correlation. Doppler imaging, tissue harmonic imaging, and other US techniques can be used to identify subtle lesions. Although malignant breast lesions may appear probably benign at second-look US, decision making for biopsy must be based primarily on MR imaging findings. In sonographically occult, MR imaging-detected lesions with suspicious MR imaging features, the probability of malignancy is much higher than 2%, and MR imaging-guided biopsy must be performed.
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Affiliation(s)
- Vivian Youngjean Park
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
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Abstract
The indications, technique, results and limitations of MRI vacuum-assisted breast biopsies are discussed from a review of the literature. This was initially a home-grown technique and its development was slowed down by several factors. As a result of major technical advances, it has become a reliable and very consistent procedure with a low rate of underestimation. It is now an undisputed technique when suspicious MRI enhancement is seen with no corresponding mammography or ultrasound features.
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Affiliation(s)
- R Plantade
- Nice Europe Imaging Centre, 15, rue Alberti, 06000 Nice, France.
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, Paris Public Hospitals Health Service (AP-HP), Pierre et Marie Curie University Oncology Institute, 4, rue de la Chine, 75020 Paris, France
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Chae EY, Shin HJ, Kim HJ, Yoo H, Baek S, Cha JH, Kim HH. Diagnostic performance of automated breast ultrasound as a replacement for a hand-held second-look ultrasound for breast lesions detected initially on magnetic resonance imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2246-2254. [PMID: 24035627 DOI: 10.1016/j.ultrasmedbio.2013.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 07/04/2013] [Accepted: 07/14/2013] [Indexed: 06/02/2023]
Abstract
To evaluate the diagnostic performance of automated breast ultrasound (ABUS) after breast magnetic resonance imaging (MRI) as a replacement for hand-held second-look ultrasound (HH-SLUS), we evaluated 58 consecutive patients with breast cancer who had additional suspicious lesions on breast MRI. All patients underwent HH-SLUS and ABUS. Three breast radiologists evaluated the detectability, location, characteristics and conspicuity of lesions on ABUS. We also evaluated inter-observer variability and compared the results with HH-SLUS results. Eighty additional suspicious lesions were identified on breast MRI. Fifteen of the 80 lesions (19%) were not detected on HH-SLUS. Eight of the 15 lesions (53%) were detected on ABUS, whereas the remaining 7 were not detected on ABUS. Among the 65 lesions detected on HH-SLUS, only 3 lesions were not detected on ABUS. The intra-class correlation coefficients for lesion location and size all exceeded 0.70, indicating high reliability. Moderate to fair agreement was found for mass shape, orientation, margin and Breast Imaging Reporting and Data System (BI-RADS) final assessment. Therefore, ABUS can reliably detect additional suspicious lesions identified on breast MRI and may help in the decision on biopsy guidance method (US vs. MRI) as a replacement tool for HH-SLUS.
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Affiliation(s)
- Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Decision Making for Breast Lesions Initially Detected at Contrast-Enhanced Breast MRI. AJR Am J Roentgenol 2013; 201:1376-85. [DOI: 10.2214/ajr.12.8953] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Ultrasonography (US) is an indispensable tool in breast imaging and is complementary to both mammography and magnetic resonance (MR) imaging of the breast. Advances in US technology allow confident characterization of not only benign cysts but also benign and malignant solid masses. Knowledge and understanding of current and emerging US technology, along with the application of meticulous scanning technique, is imperative for image optimization and diagnosis. The ability to synthesize breast US findings with multiple imaging modalities and clinical information is also necessary to ensure the best patient care. US is routinely used to guide breast biopsies and is also emerging as a supplemental screening tool in women with dense breasts and a negative mammogram. This review provides a summary of current state-of-the-art US technology, including elastography, and applications of US in clinical practice as an adjuvant technique to mammography, MR imaging, and the clinical breast examination. The use of breast US for screening, preoperative staging for breast cancer, and breast intervention will also be discussed.
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Affiliation(s)
- Regina J Hooley
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042, USA.
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Belloni E, Panizza P, Ravelli S, De Cobelli F, Gusmini S, Losio C, Sassi I, Perseghin G, Del Maschio A. MR-guided stereotactic breast biopsy using a mixed ferromagnetic-nonmagnetic coaxial system with 12- to 18-gauge needles: clinical experience and long-term outcome. LA RADIOLOGIA MEDICA 2013; 118:1137-48. [PMID: 23801401 DOI: 10.1007/s11547-013-0954-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 04/10/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE This study investigated the clinical application of a magnetic-resonance (MR)-guided breast biopsy (MRBB) system consisting of a nonmagnetic coaxial needle and a ferromagnetic core biopsy needle. MATERIALS AND METHODS MRBB was performed on 70 breast lesions. The biopsy device consisted of a nonmagnetic 14- to 16-gauge coaxial needle and a ferromagnetic 16- to 18-gauge biopsy needle. RESULTS Of the 70 lesions, 29 were malignant and 41 nonmalignant. All 29 malignant lesions underwent surgery and were confirmed as malignant at final histology. Of the 41 nonmalignant lesions, 35 underwent follow-up breast MR imaging (mean, 26 ± 19 months), which demonstrated no lesions changes; six lesions underwent surgery because of poor radiological-pathological correlation; of these 6 lesions, 3 were nonmalignant, one was borderline (lobular carcinoma in situ) and two were malignant (well-differentiated tubular carcinoma and infiltrating ductal carcinoma). Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 93.5%, 100%, 100%, 95.1% and 97.1% if the lobular carcinoma in situ was considered a nonmalignant histological result, and 90.6%, 100%, 100%, 92.7% and 95.7% if the lobular carcinoma in situ was considered malignant. CONCLUSIONS MRBB with a ferromagnetic-nonmagnetic coaxial system represented an easy way to perform a biopsy procedure and was easily applicable in the routine clinical setting.
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Affiliation(s)
- Elena Belloni
- Radiology Department, Guglielmo da Saliceto Hospital, Cantone del Cristo, 29100, Piacenza, Italy,
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Quantitative ultrasound image analysis of axillary lymph node status in breast cancer patients. Int J Comput Assist Radiol Surg 2013; 8:895-903. [DOI: 10.1007/s11548-013-0829-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/06/2013] [Indexed: 11/27/2022]
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Oxner CR, Vora L, Yim J, Kruper L, Ellenhorn JD. Magnetic Resonance Imaging-Guided Breast Biopsy in Lesions Not Visualized by Mammogram or Ultrasound. Am Surg 2012. [DOI: 10.1177/000313481207801017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of magnetic resonance imaging (MRI) for the diagnosis and evaluation of breast lesions is still in evolution. The aim of this study was to evaluate the outcome of MR-guided biopsy for suspicious lesions seen on MRI but not visualized by mammography or ultrasound. A retrospective review was conducted on all patients undergoing MRI-guided core needle biopsy at a National Cancer Institute-designated comprehensive cancer center. Biopsies were performed using a 1.5-Tesla MR with a seven-channel breast coil taking six cores in a clock face configuration with a 10-gauge vacuum-assisted VACORA biopsy device. One hundred twenty-seven patients underwent 187 biopsies without major complication. The lesion size ranged from 4 to 12 mm. Pathology on MRI-guided core biopsy material revealed 126 (68%) benign lesions. Of these, 12 were intraductal papillomas and two were fibroadenomas. Sixty-one (32%) were deemed clinically significant and included the following pathology: invasive cancer 19 patients (10%), ductal carcinoma in situ (DCIS) in 25 patients (13%), atypical ductal hyperplasia (ADH) 15 patients (8%), and lobular carcinoma in situ in one patient (1%). There were two specimens upgraded from ADH to DCIS and one specimen that was biopsied was called ADH but there was no residual atypia on final pathology. With a median follow-up of 24 months, there were no patients with benign pathology returning with a clinically significant lesion later. MRI-guided biopsy provides an accurate and safe method for sampling suspicious lesions when no other reasonable means of biopsy is available. MRI-guided biopsy yielded clinically significant findings in approximately one-third of the sampled specimens. This technique can provide a good representative sample of clinically significant pathology. MRI-guided biopsy is a relatively new modality, which can provide a nonsurgical diagnostic specimen in the absence of mammographic or ultrasound findings.
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Affiliation(s)
| | - Lalit Vora
- From City of Hope National Medical Center, Los Angeles, California
| | - John Yim
- From City of Hope National Medical Center, Los Angeles, California
| | - Laura Kruper
- From City of Hope National Medical Center, Los Angeles, California
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Fausto A, Casella D, Mantovani L, Giacalone G, Volterrani L. Clinical value of second-look ultrasound: Is there a way to make it objective? Eur J Radiol 2012; 81 Suppl 1:S36-40. [DOI: 10.1016/s0720-048x(12)70015-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Impact of real-time virtual sonography, a coordinated sonography and MRI system that uses an image fusion technique, on the sonographic evaluation of MRI-detected lesions of the breast in second-look sonography. Breast Cancer Res Treat 2012; 134:1179-88. [DOI: 10.1007/s10549-012-2163-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
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Outcome analysis of 9-gauge MRI-guided vacuum-assisted core needle breast biopsies. AJR Am J Roentgenol 2012; 198:292-9. [PMID: 22268171 DOI: 10.2214/ajr.11.7594] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to correlate 9-gauge MRI-guided vacuum-assisted breast biopsy with surgical histologic findings to determine the upgrade rate and to correlate the frequency of MRI-guided vacuum-assisted breast biopsy cancer diagnosis with breast MRI indications and enhancement characteristics of targeted lesions. MATERIALS AND METHODS A database search was performed of all MRI-guided vacuum-assisted breast biopsies performed from January 1, 2005, to September 31, 2010. The breast MRI indications, history, age, risk factors, lesion size, enhancement characteristics, and pathologic diagnoses at MRI-guided vacuum-assisted breast biopsy and at surgery were documented. Fisher exact test and analysis of variance were used for statistical analysis. RESULTS A total of 218 lesions underwent MRI-guided vacuum-assisted breast biopsy in 197 women (mean age, 52 years; range, 28-76 years), of which 85 (39%) had surgical correlation. Of the 218 lesions, 48 (22%) were malignant, 133 (61%) were benign, and 37 (17%) were high risk according to MRI-guided vacuum-assisted breast biopsy. Ten of 85 lesions (12%) were upgraded to malignancy at surgery, with a final malignancy rate of 25%. The frequency of malignancy was significantly higher in patients presenting for diagnostic (50/177 [28%]) versus screening (4/41 [10%]; p < 0.05) evaluation, patients with ipsilateral cancer (22/49 [45%]; p < 0.001), and lesions with washout kinetics (34/103 [33%]; p < 0.05) and was relatively higher in lesions with nonmasslike enhancement (26/76 [34%]; p = 0.07), which represented ductal carcinoma in situ in the majority of cases (17/26 [65%]; p < 0.005). CONCLUSION Patients with ipsilateral cancer who have additional suspicious lesions identified on MRI require careful evaluation and biopsy to exclude additional sites of cancer that may impact surgical management.
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Leung JW. Utility of Second-Look Ultrasound in the Evaluation of MRI-Detected Breast Lesions. Semin Roentgenol 2011; 46:260-74. [DOI: 10.1053/j.ro.2011.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Laguna AD, Arranz SJ, Checa VQ, Roca SA, Jiménez DE, Oliver-Goldaracena J. Sonographic findings of additional malignant lesions in breast carcinoma seen by second look ultrasound. J Clin Imaging Sci 2011; 1:34. [PMID: 21966631 PMCID: PMC3177465 DOI: 10.4103/2156-7514.82338] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 06/13/2011] [Indexed: 11/18/2022] Open
Abstract
Objective: The aim is to show ultrasound (US) findings of additional malignant lesions of breast carcinoma visualized on targeted second-look US that were not identified by mammography or US prior to the time of diagnosis. Materials and Methods: A double-blind retrospective review of the US results from January 2008 through August 2010 of 228 patients with known breast cancer was conducted by two expert radiologists. The focus of the review was on the second-look US characteristics (following BI-RADS criteria) of 26 documented additional malignant lesions of the 76 with successful sonographic correlation from the 123 lesions detected by magnetic resonance imaging (MRI). All of them, before the MRI, had an initial mammography and a US with a histopathological biopsy of the primary lesion. Results: Approximately 60 to 70% of the findings were classified as BI-RADS 2 and BI-RADS 3, while assessing the final US category. The review of the second-look US showed the size of the second malignant additional lesion ranged from 3 to 22 mm, of which 90% were smaller than 10 mm and 66% were smaller than 7 mm. Conclusions: Most additional malignant lesions, nonpalpable carcinomas, which were previously not detected by mammography and US at first-look diagnosis, were detected by a targeted second-look US examination. These lesions were of category BI-RADS 2 and BI-RADS 3 and smaller than 7 mm.
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Affiliation(s)
- Ana Delgado Laguna
- Department of Radiology, Alcorcon University Hospital Foundation, Madrid, Spain
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Luciani ML, Pediconi F, Telesca M, Vasselli F, Casali V, Miglio E, Passariello R, Catalano C. Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound. Radiol Med 2011; 116:886-904. [PMID: 21293943 DOI: 10.1007/s11547-011-0630-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 07/27/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI). MATERIALS AND METHODS Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up. RESULTS Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered. CONCLUSIONS Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.
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Affiliation(s)
- M L Luciani
- Department of Radiological Sciences, University of Rome "La Sapienza", V.le Regina Elena 324, 00161 Rome, Italy.
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Sardanelli F. Additional findings at preoperative MRI: a simple golden rule for a complex problem? Breast Cancer Res Treat 2010; 124:717-21. [PMID: 20803241 DOI: 10.1007/s10549-010-1144-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Francesco Sardanelli
- Dipartimento di Scienze Medico-Chirurgiche, Unità di Radiologia, Università degli Studi di Milano, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
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