Skip to main content

Advertisement

SpringerLink
Log in

Contrast-enhanced ultrasound-guided biopsy of suspicious breast lesions on contrast-enhanced mammography and contrast-enhanced MRI: a case series

  • Original Article–Breast & Thyroid
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Purpose

To assess the effectiveness of contrast-enhanced ultrasound (CEUS) in guiding biopsies of breast lesions that were detected on contrast-enhanced mammography (CEM) or contrast-enhanced breast MRI (CE-MRI) but were not clearly visible on B-mode ultrasound (B-US).

Methods

In this study, 23 lesions in 16 patients were selected for CEUS-guided biopsy due to poor visualization on B-US despite being detected on CEM (n = 20) or CE-MRI (n = 3). B-US, color Doppler ultrasound (CDUS), and CEUS were used to visualize the suspicious lesions, followed by a CEUS-guided core needle biopsy using Sonazoid as the contrast agent. The accuracy of the biopsy was assessed based on pathology-radiology concordance and 12-month imaging follow-up. The conspicuity scores for lesion visualization were evaluated using a 5-point conspicuity scale agreed upon by two breast radiologists.

Results

The enhancing lesions detected on CEM/CE-MRI had an average size of 1.6 ± 1.3 cm and appeared as mass-enhancing (61%) or non-mass-enhancing (39%). The lesions had mean conspicuity scores of 2.30 on B-US, 2.78 on CDUS, and 4.61 on CEUS, with 96% of the lesions showing contrast enhancement on CEUS. CEUS-guided biopsy showed increased visibility in 96% and 91% of the lesions compared to B-US and CDUS, respectively. The overall accuracy of CEUS-guided biopsy was 100% based on concordance with histology and 12-month follow-up.

Conclusions

CEUS enhances the visibility of suspicious CEM/CE-MRI lesions that are poorly visible on B-US during biopsy procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data sharing is restricted by the Kaohsiung Veterans General Hospital IRB due to strict regulations for ethical issues. Access to data will be subject to a data sharing agreement approved by Kaohsiung Veterans General Hospital IRB.

Abbreviations

B-US:

B-mode ultrasound

CDUS:

Color Doppler ultrasound

CEUS:

Contrast-enhanced ultrasound

CE-MRI:

Contrast-enhanced breast MRI

CEUS-CNB:

Contrast-enhanced ultrasound-guided core needle biopsy

CEM:

Contrast-enhanced mammography

CE-MRI:

Contrast-enhanced breast MRI

References

  1. Chung YE, Kim KW. Contrast-enhanced ultrasonography: advance and current status in abdominal imaging. Ultrasonography. 2015;34:3–18.

    Article  PubMed  Google Scholar 

  2. Miyamoto Y, Ito T, Takada E, et al. Efficacy of sonazoid (perflubutane) for contrast-enhanced ultrasound in the differentiation of focal breast lesions: phase 3 multicenter clinical trial. AJR Am J of roentgenol. 2014;202:W400–7.

    Article  Google Scholar 

  3. Zhou SC, Le J, Zhou J, et al. The role of contrast-enhanced ultrasound in the diagnosis and pathologic response prediction in breast cancer: a meta-analysis and systematic review. Clin Breast Cancer. 2020;20:e490–509.

    Article  PubMed  Google Scholar 

  4. Zhang F, Jin L, Li G, et al. The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria. Br J Radiol. 2021;94:20200880.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Du LW, Liu HL, Gong HY, et al. Adding contrast-enhanced ultrasound markers to conventional axillary ultrasound improves specificity for predicting axillary lymph node metastasis in patients with breast cancer. Br J Radiol. 2021;94:20200874.

    Article  PubMed  Google Scholar 

  6. Park HS, Kim YJ, Yu MH, et al. Real-time contrast-enhanced sonographically guided biopsy or radiofrequency ablation of focal liver lesions using perflurobutane microbubbles (sonazoid): value of Kupffer-phase imaging. J Ultrasound Med. 2015;34:411–21.

    Article  PubMed  Google Scholar 

  7. 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 of roentgenol. 2009;193:1025–9.

    Article  Google Scholar 

  8. James J. Contrast-enhanced spectral mammography (CESM)-guided breast biopsy as an alternative to MRI-guided biopsy. Br J Radiol. 2022;95:20211287.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bick U, Trimboli RM, Athanasiou A, et al. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European society of breast imaging. Insights Imag. 2020;11:12.

    Article  Google Scholar 

  10. Chikarmane SA, Jin B, Giess CS. Accuracy of MRI-directed ultrasound and subsequent ultrasound-guided biopsy for suspicious breast MRI findings. Clin Radiol. 2020;75:185–93.

    Article  CAS  PubMed  Google Scholar 

  11. Moon WK, Im JG, Noh DY, et al. Nonpalpable breast lesions: evaluation with power doppler US and a microbubble contrast agent-initial experience. Radiology. 2000;217:240–6.

    Article  CAS  PubMed  Google Scholar 

  12. Chou YH, Liang JD, Wang SY, et al. Safety of Perfluorobutane (Sonazoid) in characterizing focal liver lesions. J med ultrasound. 2019;27:81–5.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Raza S, Baum JK. Solid breast lesions: evaluation with power Doppler US. Radiology. 1997;203:164–8.

    Article  CAS  PubMed  Google Scholar 

  14. Blows FM, Driver KE, Schmidt MK, et al. Subtyping of breast cancer by immunohistochemistry to investigate a relationship between subtype and short and long term survival: a collaborative analysis of data for 10,159 cases from 12 studies. PLoS Med. 2010;7:e1000279.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ghaderi KF, Phillips J, Perry H, et al. Contrast-enhanced Mammography: current applications and future directions. Radiographics. 2019;39:1907–20.

    Article  PubMed  Google Scholar 

  16. Landmark KE, Johansen PW, Johnson JA, et al. Pharmacokinetics of perfluorobutane following intravenous bolus injection and continuous infusion of sonazoid in healthy volunteers and in patients with reduced pulmonary diffusing capacity. Ultrasound Med Biol. 2008;34:494–501.

    Article  PubMed  Google Scholar 

  17. Schrading S, Schild H, Kuhr M, et al. Effects of tamoxifen and aromatase inhibitors on breast tissue enhancement in dynamic contrast-enhanced breast MR imaging: a longitudinal intraindividual cohort study. Radiology. 2014;271:45–55.

    Article  PubMed  Google Scholar 

  18. Lee JY, Minami Y, Choi BI, et al. The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using sonazoid. Ultrasonography. 2020;39:191–220.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by grants from Kaohsiung Veterans Hospital Research Fund (KSVGH111-109).

Author information

Authors and Affiliations

  1. Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, 813, Taiwan, ROC

    Pi-Yi Huang, Meng-Yuan Tsai, Jer-Shyung Huang, Pei-Ying Lin & Chen-Pin Chou

  2. Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan, ROC

    Chen-Pin Chou

Authors
  1. Pi-Yi Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meng-Yuan Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jer-Shyung Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pei-Ying Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chen-Pin Chou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chen-Pin Chou.

Ethics declarations

Conflict of interest

Pi-Yi Huang, Meng-Yuan Tsai, Jer-Shyung Huang, Pei-Ying Lin, and Chen-Pin Chou declare no conflicts of interest.

Ethical approval

All procedures followed the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, PY., Tsai, MY., Huang, JS. et al. Contrast-enhanced ultrasound-guided biopsy of suspicious breast lesions on contrast-enhanced mammography and contrast-enhanced MRI: a case series. J Med Ultrasonics 50, 521–529 (2023). https://doi.org/10.1007/s10396-023-01345-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-023-01345-4

Keywords

Search

Navigation