Abstract
Purpose
The aim of this study was to verify the utility of second-look ultrasound (US) using real-time virtual sonography (RVS), a magnetic resonance imaging (MRI)/US fusion technique, in identifying MRI-detected breast lesions with non-mass enhancement (NME).
Methods
Consecutive patients who had one or more NME lesions detected by MRI yet occult on the subsequent second-look US in conventional B (cB)-mode imaging were enrolled in the study between June 2015 and April 2020. Supine MRI of the lesions was performed and, using its data, second-look US using RVS was performed.
Results
Twenty patients with 21 NME lesions were included. The overall median lesion size on prone MRI was 23 mm (range, 5–63 mm). Supine MRI identified all the 21 NME lesions, and second-look US using RVS successfully detected 18 (86%) of them. RVS-guided biopsy was performed for histopathological evaluation, showing that nine of the 18 lesions were benign and the other nine malignant. Of the nine malignant lesions, two (22%) were invasive cancer and seven (78%) were ductal carcinoma in situ. In four of five patients who underwent prone MRI for preoperative evaluation, the diagnosis was benign and surgery was conducted as originally planned. In the other patient, the diagnosis was malignant and contralateral breast-conserving surgery was added. Three (14%) of the 21 NME lesions had no RVS correlates and were judged to be benign after 24-month follow-up.
Conclusion
The results suggest that second-look US using RVS helps identify MRI-detected NME lesions that are occult on cB-mode second-look US.
Similar content being viewed by others
References
American College of Radiology. ACR BI-RADS Atlas. ACR. 5th edition. Reston, ACR. 2013.
Abe H, Schmidt RA, Shah RN, et al. MR-directed (“Second-Look”) ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings. AJR Am J Roentgenol. 2010;194:370–7.
Demartini WB, Eby PR, Peacock S, et al. Utility of targeted sonography for breast lesions that were suspicious on MRI. AJR Am J Roentgenol. 2009;192:1128–34.
Meissnitzer M, Dershaw DD, Lee CH, et al. Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol. 2009;193:1025–9.
LaTrenta LR, Menell JH, Morris EA, et al. Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology. 2003;227:856–61.
Spick C, Baltzer PA. Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 2014;273:401–9.
Hsu HH, Chang TH, Chou YC, et al. breast nonmass enhancement detected with MRI: uility and lesion characterization with second-look ultrasonography. Breast J. 2015;21:579–87.
Hollowell L, Price E, Arasu V, et al. Lesion morphology on breast MRI affects targeted ultrasound correlation rate. Eur Radiol. 2015;25:1279–84.
Goto M, Yuen S, Akazawa K, et al. The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy. Eur Radiol. 2012;22:1255–64.
Wang LC, Sullivan M, Du H, et al. US appearance of ductal carcinoma in situ. Radiographics. 2013;33:213–28.
Brennan SB. Breast magnetic resonance imaging for the interventionalist: magnetic resonance imaging-guided vacuum-assisted breast biopsy. Tech Vasc Interv Radiol. 2014;17:40–8.
Price ER. Magnetic resonance imaging-guided biopsy of the breast: fundamentals and finer points. Magn Reson Imaging Clin N Am. 2013;21:571–81.
Nakano S, Kousaka J, Fujii K, et al. 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.
Nakano S, Yoshida M, Fujii K, et al. Real-time virtual sonography, a coordinated sonography and MRI system that uses magnetic navigation, improves the sonographic identification of enhancing lesions on breast MRI. Ultrasound Med Biol. 2012;38:42–9.
Nakano S, Yoshida M, Fujii K, et al. Fusion of MRI and sonography image for breast cancer evaluation using real-time virtual sonography with magnetic navigation: first experience. Jpn J Clin Oncol. 2009;39:552–9.
Watanabe R, Ando T, Osawa M, et al. Second-look US using real-time virtual sonography, a coordinated breast US and MRI system with electromagnetic tracking technology: a pilot study. Ultrasound Med Biol. 2017;43:2362–71.
Ando T, Ito Y, Ido M, et al. Pre-operative planning using real-time virtual sonography, an MRI/ultrasound image fusion technique, for breast-conserving surgery in patients with non-mass enhancement on breast MRI: a preliminary study. Ultrasound Med Biol. 2018;44:1364–70.
Nakano S, Ando T, Tetsuka R, et al. Reproducible surveillance breast ultrasound using an image fusion technique in a short-interval follow-up for BI-RADS 3 lesions: a pilot study. Ultrasound Med Biol. 2014;40:1049–57.
Park AY, Seo BK, Han H, et al. Clinical value of real-time ultrasonography-MRI fusion imaging for second-look examination in preoperative breast cancer patients: additional lesion detection and treatment planning. Clin Breast Cancer. 2018;18:261–9.
Komforti MK, Harmon BE. Educational case: ductal carcinoma in situ (DCIS). Acad Pathol. 2019;6:2374289519888727.
Kim SJ, Park YM, Jung HK. Nonmasslike lesions on breast sonography: comparison between benign and malignant lesions. J Ultrasound Med. 2014;33:421–30.
Uematsu T, Takahashi K, Nishimura S, et al. Real-time virtual sonography examination and biopsy for suspicious breast lesions identified on MRI alone. Eur Radiol. 2016;26:1064–72.
Fausto A, Fanizzi A, Volterrani L, et al. Feasibility, image quality and clinical evaluation of contrast-enhanced breast MRI performed in a supine position compared to the standard prone position. Cancers (Basel). 2020. https://doi.org/10.3390/cancers12092364.
Kang DK, Jung Y, Han S, et al. Clinical utility of real-time MR-navigated ultrasound with supine breast MRI for suspicious enhancing lesions not identified on second-look ultrasound. Ultrasound Med Biol. 2017;43:412–20.
Uematsu T. Real-time virtual sonography (RVS)-guided vacuum-assisted breast biopsy for lesions initially detected with breast MRI. Jpn J Radiol. 2013;31:826–31.
Aribal E, Tureli D, Kucukkaya F, et al. Volume navigation technique for ultrasound-guided biopsy of breast lesions detected only at MRI. AJR Am J Roentgenol. 2017;208:1400–9.
Carbonaro LA, Tannaphai P, Trimboli RM, et al. Contrast enhanced breast MRI: spatial displacement from prone to supine patient’s position. Preliminary results. Eur J Radiol. 2012;81:e771–4.
Nakashima K, Uematsu T, Harada TL, et al. MRI-detected breast lesions: clinical implications and evaluation based on MRI/ultrasonography fusion technology. Jpn J Radiol. 2019;37:685–93.
Choe J, Chikarmane SA, Giess CS. Nonmass findings at breast US: definition, classifications, and differential diagnosis. Radiographics. 2020;40:326–35.
Uematsu T. Non-mass-like lesions on breast ultrasonography: a systematic review. Breast Cancer. 2012;19:295–301.
Acknowledgements
We thank Yukiko Kuru (Faculty of Foreign Languages, Aichi Medical University School of Medicine) for the English editing. We also thank Wataru Oohashi (Division of Biostatistics, Clinical Research Center, Aichi Medical University Hospital) for the statistical analysis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to declare.
Ethical statements
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
Informed consent
Informed consent was obtained from all patients for being included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Goto, M., Nakano, S., Saito, M. et al. Evaluation of an MRI/US fusion technique for the detection of non-mass enhancement of breast lesions detected by MRI yet occult on conventional B-mode second-look US. J Med Ultrasonics 49, 269–278 (2022). https://doi.org/10.1007/s10396-021-01175-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10396-021-01175-2