MR-Directed (“Second-Look”) Ultrasound Examination for Breast Lesions Detected Initially on MRI: MR and Sonographic Findings

Abé, Hiroyuki; Schmidt, Robert A.; Shah, Rajshri N.; Shimauchi, Akiko; Kulkarni, Kirti; Sennett, Charlene A.; Newstead, Gillian M.

doi:10.2214/ajr.09.2707

Cited by 180 publications

(146 citation statements)

References 16 publications

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“…However, with SLUS, it is more difficult to detect lesions with negative results on the initial US. Also, most lesions larger than 16 mm were non-mass-like enhancements that were more difficult to detect than masses (10). There was no statistically significant correlation between the cancer rate and the lesion type.…”

Section: • January-february 2015 • Diagnostic and Interventional Radimentioning

confidence: 83%

“…In a previous study, targeted US identified 65 of 73 additionally detected enhancing lesions (89%), and eight lesions (11%) were not visible on targeted US (14). Shin et al (11) reported that the detectability rate of SLUS was 71% (27/38), and Abe et al (10) reported that US correlation was made in 115 of 202 additionally detected enhancing lesions (57%). In this study, 72 of 85 unexpected enhancing lesions (85%) were detected on SLUS, demonstrating a relatively high level of detectability compared with the previous studies.…”

Section: • January-february 2015 • Diagnostic and Interventional Radimentioning

confidence: 94%

“…Also US guidance can be used for biopsy instead of MRI guidance. Nevertheless, few studies have reported the characterization and meaning of additionally detected lesions on preoperative MRI and SLUS of breast cancer patients (10,11). In addition, there has not been a study examining the long-term follow-up results of additional enhancing lesions that could not be detected by US and could not be biopsied with MRI guidance due to lack of equipment, as is the case in our center.…”

mentioning

confidence: 88%

“…Several reports demonstrated the usefulness of SLUS (5,10,11). If a lesion can be detected on SLUS, a new malignant lesion can be differentiated from a false-positive enhancing lesion on MRI to conclude the diagnostic workup.…”

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confidence: 99%

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Follow-up design of unexpected enhancing lesions on preoperative MRI of breast cancer patients

Cheung¹,

Moon²

2015

Diagn Interv Radiol

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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. RESULTSOf 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. CONCLUSIONIn 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. Dynamic contrast-enhanced magnetic resonance imaging (MRI) has been the most accurate technique for the detection and delineation of invasive and some in situ breast cancers (1-6). Despite the high sensitivity of MRI (83%-100%), the reported specificity of this modality is relatively low and ranges from 40% to 80% (7,8). MRI identifies additional lesions much more frequently than other imaging modalities do (9). On preoperative MRI of breast cancer patients, other enhancing lesions are frequently detected in addition to the index cancer. Since the probability of malignancy is high for additionally detected lesions on MRI of breast cancer patients, MRI-guided percutaneous biopsy is a reasonable next step, but it is an expensive and time-consuming procedure, and it is not yet widely available all over the world. Alternatively, ultrasonography (US)-guided biopsy is preferable, because it is less expensive and more convenient for the patients.Second-look ultrasound (SLUS) is a reevaluation method for MRI-detected lesions with the information provided by MRI. Sometimes, SLUS is used even when there is no antecedent US examination. This technique has become increasingly important for detecting unexpected enhancing lesions on MRI, especially for breast cancer patients.Several reports demonstrated the usefulness of SLUS (5, 10, 11). If a lesion can be detected on SLUS, a new malignant lesion can be differentiated from a false-positive enhancing lesion on MRI to conclude the diagnostic workup. Also US guidance can be used for biopsy instead of MRI guidance. Nevertheless, few studies have reported the characterization and meaning of additionally detected lesions on preoperative MRI and SLUS of ...

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Section: • January-february 2015 • Diagnostic and Interventional Radimentioning

confidence: 83%

Section: • January-february 2015 • Diagnostic and Interventional Radimentioning

confidence: 94%

mentioning

confidence: 88%

mentioning

confidence: 99%

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Follow-up design of unexpected enhancing lesions on preoperative MRI of breast cancer patients

Cheung¹,

Moon²

2015

Diagn Interv Radiol

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“…This requires not only to be familiar with (supine) breast US but also with (prone) breast MRI as well as with the different lesion location at the two imaging techniques. Six recent studies reported percentages of US correlate for initially MR-detected findings variable from 46% to 82% [17][18][19][20][21][22]. Pooling their results, we have a total of 1,208 findings, 759 of them with a US correlate (63%).…”

Section: Additional Findings At Preoperative Mri a Simple Golden Rulmentioning

confidence: 89%

Additional findings at preoperative MRI: a simple golden rule for a complex problem?

Sardanelli

2010

Breast Cancer Res Treat

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Can strain elastography improve the characterization of breast lesions identified during second‐look MRI‐directed sonographic examination?

Filip

Ferré

AlSharif

et al. 2019

J of Clinical Ultrasound

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Purpose To evaluate strain elastography as a complementary tool for characterization of lesions identified during second‐look MRI‐directed sonographic examination. Methods We reviewed 83 breast lesions evaluated with MRI, secondlook ultrasound (US) and strain elastography in 75 consecutive patients (median age, 56 years). US‐guided biopsies were performed in all cases. Results After histopathological examination, 44 lesions were benign, 38 were malignant and 1 was high‐risk. At MRI, the mean size of the lesions was 12 mm. Forty lesions (48.2%) appeared as masses, 30 (36.1%) as “non‐masses” and 13 (15.7%) as “foci.” At second‐look US examination, 56 (67.5%) appeared as masses (mean size, 7 mm) and 27 (32.5%) as non‐masses (mean size, 14 mm). At strain elastography, among the 39 malignant/high risk lesions, 5 (12.8%) had a score of 4 or 5, whereas 16 (41%) had a score of 1 and 2 (false negative). Among the 44 benign lesions, 36 (82%) had a score of 1 or 2, whereas none had a score of 5. Sensitivity and specificity of strain elastography in the diagnosis of breast cancer were 58% and 81%, respectively. Conclusion The addition of strain elastography offers no benefit in the characterization of lesions identified on second‐look US after breast MRI.(E1, 3).

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MR-Directed (“Second-Look”) Ultrasound Examination for Breast Lesions Detected Initially on MRI: MR and Sonographic Findings

Cited by 180 publications

References 16 publications

Follow-up design of unexpected enhancing lesions on preoperative MRI of breast cancer patients

Follow-up design of unexpected enhancing lesions on preoperative MRI of breast cancer patients

Additional findings at preoperative MRI: a simple golden rule for a complex problem?

Can strain elastography improve the characterization of breast lesions identified during second‐look MRI‐directed sonographic examination?

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