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

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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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Acknowledgments

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.

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Correspondence to Paola Clauser.

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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). https://doi.org/10.1007/s00330-015-3720-5

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  • DOI: https://doi.org/10.1007/s00330-015-3720-5

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