Skip to main content


Log in

Additional findings at preoperative breast MRI: the value of second-look digital breast tomosynthesis

  • Breast
  • Published:
European Radiology Aims and scope Submit manuscript



To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US).


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.


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 %).


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.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Peters NHGM, Borel Rinkes IHM, Zuithoff NPA et al (2008) Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology 246:116–124

    Article  PubMed  Google Scholar 

  2. Kuhl C, Weigel S, Schrading S et al (2010) Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J Clin Oncol Off J Am Soc Clin Oncol 28:1450–1457

    Article  Google Scholar 

  3. Sardanelli F, Podo F, Santoro F et al (2011) Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results. Invest Radiol 46:94–105

    Article  PubMed  Google Scholar 

  4. Liberman L, Morris EA, Dershaw DD et al (2003) MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol 180:901–910

    Article  PubMed  Google Scholar 

  5. Liberman L, Morris EA, Kim CM et al (2003) MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol 180:333–341

    Article  PubMed  Google Scholar 

  6. Ha G-W, Yi MS, Lee BK et al (2011) Clinical outcome of magnetic resonance imaging-detected additional lesions in breast cancer patients. J Breast Cancer 14:213–218

    Article  PubMed Central  PubMed  Google Scholar 

  7. Bluemke DA, Gatsonis CA, Chen MH et al (2004) Magnetic resonance imaging of the breast prior to biopsy. JAMA J Am Med Assoc 292:2735–2742

    Article  CAS  Google Scholar 

  8. Linda A, Zuiani C, Londero V, Bazzocchi M (2008) Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: distribution according to patient history of breast cancer and lesion size. Breast Edinb Scotl 17:51–57

    Article  Google Scholar 

  9. Teifke A, Lehr HA, Vomweg TW et al (2003) Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. AJR Am J Roentgenol 181:655–662

    Article  PubMed  Google Scholar 

  10. Brown J, Smith RC, Lee CH (2001) Incidental enhancing lesions found on MR imaging of the breast. AJR Am J Roentgenol 176:1249–1254

    Article  CAS  PubMed  Google Scholar 

  11. Langer SA, Horst KC, Ikeda DM et al (2005) Pathologic correlates of false positive breast magnetic resonance imaging findings: which lesions warrant biopsy? Am J Surg 190:633–640

    Article  PubMed  Google Scholar 

  12. Heywang-Köbrunner SH, Sinnatamby R, Lebeau A et al (2009) Interdisciplinary consensus on the uses and technique of MR-guided vacuum-assisted breast biopsy (VAB): results of a European consensus meeting. Eur J Radiol 72:289–294

    Article  PubMed  Google Scholar 

  13. Brennan SB, Sung JS, Dershaw DD et al (2011) Cancellation of MR imaging-guided breast biopsy due to lesion nonvisualization: frequency and follow-up. Radiology 261:92–99

    Article  PubMed  Google Scholar 

  14. Johnson KS, Baker JA, Lee SS, Soo MS (2013) Cancelation of MRI guided breast biopsies for suspicious breast lesions identified at 3.0 T MRI: reasons, rates, and outcomes. Acad Radiol 20:569–575

    Article  PubMed  Google Scholar 

  15. Meeuwis C, Mann RM, Mus RDM et al (2011) MRI-guided breast biopsy at 3T using a dedicated large core biopsy set: feasibility and initial results. Eur J Radiol 79:257–261

    Article  PubMed  Google Scholar 

  16. Leung JWT (2011) Utility of second-look ultrasound in the evaluation of MRI-detected breast lesions. Semin Roentgenol 46:260–274

    Article  PubMed  Google Scholar 

  17. LaTrenta LR, Menell JH, Morris EA et al (2003) Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology 227:856–861

    Article  PubMed  Google Scholar 

  18. Obdeijn IM, Brouwers-Kuyper EM, Tilanus-Linthorst MM et al (2000) MR imaging-guided sonography followed by fine-needle aspiration cytology in occult carcinoma of the breast. AJR Am J Roentgenol 174:1079–1084

    Article  CAS  PubMed  Google Scholar 

  19. Spick C, Baltzer PAT (2014) Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology 140474. doi:10.1148/radiol.14140474

  20. Luciani ML, Pediconi F, Telesca M et al (2011) Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound. Radiol Med (Torino) 116:886–904

    Article  CAS  Google Scholar 

  21. Houssami N, Zackrisson S (2013) Digital breast tomosynthesis: the future of mammography screening or much ado about nothing? Expert Rev Med Devices 10:583–585

    Article  CAS  PubMed  Google Scholar 

  22. Skaane P, Bandos AI, Gullien R et al (2013) Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267:47–56

    Article  PubMed  Google Scholar 

  23. Friedewald SM, Rafferty EA, Rose SL et al (2014) Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA J Am Med Assoc 311:2499–2507

    Article  CAS  Google Scholar 

  24. Park JM, Franken EA, Garg M et al (2007) Breast tomosynthesis: present considerations and future applications. Radiogr Rev Publ Radiol Soc N Am Inc 27:S231–S240

    Google Scholar 

  25. Lång K, Andersson I, Zackrisson S (2014) Breast cancer detection in digital breast tomosynthesis and digital mammography-a side-by-side review of discrepant cases. Br J Radiol 87:20140080

    Article  PubMed Central  PubMed  Google Scholar 

  26. Carbognin G, Girardi V, Calciolari C et al (2010) Utility of second-look ultrasound in the management of incidental enhancing lesions detected by breast MR imaging. Radiol Med (Torino) 115:1234–1245

    Article  CAS  Google Scholar 

  27. Demartini WB, Eby PR, Peacock S, Lehman CD (2009) Utility of targeted sonography for breast lesions that were suspicious on MRI. AJR Am J Roentgenol 192:1128–1134

    Article  PubMed  Google Scholar 

  28. Beran L, Liang W, Nims T et al (2005) Correlation of targeted ultrasound with magnetic resonance imaging abnormalities of the breast. Am J Surg 190:592–594

    Article  PubMed  Google Scholar 

  29. Meissnitzer M, Dershaw DD, Lee CH, Morris EA (2009) Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol 193:1025–1029

    Article  PubMed  Google Scholar 

  30. Schnall MD, Blume J, Bluemke DA et al (2005) MRI detection of distinct incidental cancer in women with primary breast cancer studied in IBMC 6883. J Surg Oncol 92:32–38

    Article  PubMed  Google Scholar 

  31. Sardanelli F, Giuseppetti GM, Panizza P et al (2004) Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol 183:1149–1157

    Article  PubMed  Google Scholar 

  32. Sardanelli F, Boetes C, Borisch B et al (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer Oxf Engl 1990 46:1296–1316

    Google Scholar 

  33. Lehman CD, Gatsonis C, Kuhl CK et al (2007) MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 356:1295–1303

    Article  CAS  PubMed  Google Scholar 

  34. Trop I, Labelle M, David J et al (2010) Second-look targeted studies after breast magnetic resonance imaging: practical tips to improve lesion identification. Curr Probl Diagn Radiol 39:200–211

    Article  PubMed  Google Scholar 

  35. Bernardi D, Ciatto S, Pellegrini M et al (2012) Prospective study of breast tomosynthesis as a triage to assessment in screening. Breast Cancer Res Treat 133:267–271

    Article  PubMed  Google Scholar 

  36. Rose SL, Tidwell AL, Bujnoch LJ et al (2013) Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol 200:1401–1408

    Article  PubMed  Google Scholar 

  37. Carbonaro LA, Tannaphai P, Trimboli RM et al (2012) Contrast enhanced breast MRI: spatial displacement from prone to supine patient’s position. Preliminary results. Eur J Radiol 81:e771–e774

    Article  PubMed  Google Scholar 

  38. Dershaw DD (2013) Large core needle biopsy with tomosynthesis guidance: another development in breast imaging technology. Breast J 19:1–3

    Article  PubMed  Google Scholar 

  39. Viala J, Gignier P, Perret B et al (2013) Stereotactic vacuum-assisted biopsies on a digital breast 3D-tomosynthesis system. Breast J 19:4–9

    Article  PubMed  Google Scholar 

Download references


The authors thank Miles Kirchin for English text review.

The scientific guarantor of this publication is Chiara Zuiani. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational, multicenter study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Paola Clauser.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Clauser, P., Carbonaro, L.A., Pancot, M. et al. Additional findings at preoperative breast MRI: the value of second-look digital breast tomosynthesis. Eur Radiol 25, 2830–2839 (2015).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: