Six-year prospective evaluation of second-look US with volume navigation for MRI-detected additional breast lesions

Abstract

Objective

The aim of this study is to present a 6-year prospective evaluation of second-look ultrasound (US) using volume navigation (V Nav) for MRI-detected additional breast lesions.

Methods

After IRB approvals in both institutions, 1930 consecutive prone MRI breast examinations in 1437 patients were prospectively evaluated. All patients with an MRI-detected additional lesion underwent second-look US, and if occult, contrast-enhanced MRI in supine position was performed for US and MRI co-registration. For patients with breast hypertrophy, MRI-guided biopsy was performed directly. Pathologic examination was the standard of reference. One-way ANOVA and chi-square tests were used.

Results

In 490 MRI examinations (25.4%, 490/1930), at least one additional breast lesion was detected for a total of 722 only MRI-detected lesions. Second-look US identified 549 additional lesions (23 ± 8 mm); 362 (65.9%, 362/549) proved benign at pathology and 187 (34.1%, 187/549) malignant. Second-look US with V Nav identified 151 additional lesions (17 ± 9 mm, p = n.s.); 67 (44.4%, 67/151) proved benign at pathology and 84 (55.6%, 84/151) malignant. MRI-guided biopsy was performed on 22 additional breast lesions (22 ± 8 mm, p = n.s.); pathology revealed 20 (90.9%, 20/22) benign lesions and 2 (9.1%, 2/22) malignant ones. Mass lesions were significantly higher in the second-look US group (p < 0.001). No significant difference in lesion dimension was found between the three groups (p = 0.729).

Conclusions

Second-look US with V Nav can be effective in detecting a large number of additional breast lesions occult at second-look US and to biopsy a significant number of malignant lesions safely and irrespective of distance from skin or lesion position.

Key Points

• Second-look US with volume navigation is effective in detecting occult additional lesions.

• Permits safe biopsies irrespective of position and depth

• Reduces the need for MRI-guided biopsy

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Graph 1
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Abbreviations

BI-RADS :

Breast Imaging Reporting and Data System

CT:

Computed tomography

DCIS:

Ductal carcinoma in situ

Gd-BOPTA:

Gadobenic acid

IDC:

Invasive ductal carcinoma

ILC:

Invasive lobular carcinoma

LAVA:

Liver acquisition volume acceleration

MRI:

Magnetic resonance imaging

THIVE SPAIR:

Three-dimensional turbo field echo sequence with T1-weighted high-resolution isotropic examination volume and spectral attenuated inversion recovery

US:

Ultrasound

V Nav:

MRI volume navigation

VAB:

Vacuum-assisted biopsy

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Funding

The authors state that this work has not received any funding.

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Authors

Corresponding author

Correspondence to Alfonso Fausto.

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Guarantor

The scientific guarantor of this publication is Prof. Luca Volterrani.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Diagnostic study/observational

• Multicentre study

Electronic supplementary material

Supplementary material

Video – Ultrasound images (left side) with the corresponding multiplanar reconstructed MR images (right side) of a 49-year-old woman with rounded-irregular lesion of 11 mm in the lower external quadrant of the right breast detected at second-look US. However, second-look US with volume navigation (V Nav) revealed the intraductal component extension without any correlation at US images. Pathology demonstrated an invasive ductal carcinoma of 13 mm and a ductal carcinoma in situ of 47 mm impossible to detect with second-look US. The green box represents the corresponding US area on MR image showing additional lesion shape and conspicuity. (MOV 830 kb)

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Cite this article

Fausto, A., Bernini, M., La Forgia, D. et al. Six-year prospective evaluation of second-look US with volume navigation for MRI-detected additional breast lesions. Eur Radiol 29, 1799–1808 (2019). https://doi.org/10.1007/s00330-018-5765-8

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Keywords

  • Breast ultrasonography
  • Magnetic resonance imaging
  • Breast tumours
  • Multimodal imaging
  • Image-guided biopsy