Skip to main content

Advertisement

SpringerLink
Log in

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

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

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.

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
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. American College of Radiology. ACR BI-RADS Atlas. ACR. 5th edition. Reston, ACR. 2013.

  2. 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.

    Article  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. Hollowell L, Price E, Arasu V, et al. Lesion morphology on breast MRI affects targeted ultrasound correlation rate. Eur Radiol. 2015;25:1279–84.

    Article  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. Wang LC, Sullivan M, Du H, et al. US appearance of ductal carcinoma in situ. Radiographics. 2013;33:213–28.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Price ER. Magnetic resonance imaging-guided biopsy of the breast: fundamentals and finer points. Magn Reson Imaging Clin N Am. 2013;21:571–81.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. Komforti MK, Harmon BE. Educational case: ductal carcinoma in situ (DCIS). Acad Pathol. 2019;6:2374289519888727.

    Article  Google Scholar 

  21. Kim SJ, Park YM, Jung HK. Nonmasslike lesions on breast sonography: comparison between benign and malignant lesions. J Ultrasound Med. 2014;33:421–30.

    Article  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. 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.

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. 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.

    Article  Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. Choe J, Chikarmane SA, Giess CS. Nonmass findings at breast US: definition, classifications, and differential diagnosis. Radiographics. 2020;40:326–35.

    Article  Google Scholar 

  30. Uematsu T. Non-mass-like lesions on breast ultrasonography: a systematic review. Breast Cancer. 2012;19:295–301.

    Article  Google Scholar 

Download references

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

  1. Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan

    Manami Goto, Shogo Nakano, Masayuki Saito, Hirona Banno, Yukie Ito, Mirai Ido, Takahito Ando, Junko Kousaka & Kimihito Fujii

  2. Department of Radiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan

    Kojiro Suzuki

Authors
  1. Manami Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shogo Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masayuki Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hirona Banno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukie Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mirai Ido
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takahito Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Junko Kousaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kimihito Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kojiro Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shogo Nakano.

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

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-021-01175-2

Keywords

Search

Navigation