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Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound

Il ruolo del second-look ecografico nella caratterizzazione delle lesioni riscontrate occasionalmente alla risonanza magnetica preoperatoria della mammella

  • Breast Radiology / Senologia
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI).

Materials and methods

Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up.

Results

Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered.

Conclusions

Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato dimostrare prospetticamente il ruolo del second-look ecografico nella valutazione delle lesioni occasionali alla risonanza magnetica (RM) della mammella preoperatoria.

Materiali e metodi

Tra il 2004 ed il 2007, 182 pazienti con lesioni maligne all’ecografia e/o mammografia e confermate dall’esame citologico/istologico sono state sottoposte a RM della mammella con mezzo di contrasto (MdC) per stadiazione preoperatoria. Le pazienti con lesioni incidentali sono state rivalutate con second-look ecografico mirato. La diagnosi di tali lesioni è stata formulata sulla base della biopsia o del follow-up a 24 mesi.

Risultati

La RM ha identificato 55 nuove lesioni in 46/182 (25,2%) pazienti. 42/55 (76,3%) lesioni sono state individuate mediante il second-look ecografico in 38/46 (82,6%) pazienti. La malignità è stata confermata per 24/42 (57,1%) lesioni e per 7/13 (53,8%) lesioni senza corrispettivo ecografico. Il second-look ecografico ha identificato 8/9 (88,8%) lesioni classificate secondo il breast imaging reporting and data system (BI-RADS) 5, 16/22 (72,7%) BI-RADS 4 e 18/24 (75%) BI-RADS 3. Sensibilità, specificità, accuratezza, valore predittivo positivo (VPP) e valore predittivo negativo (VPN) per identificazione e diagnosi sono risultati del 100%, 88,9%, 94,6%, 90,3% and 100% per la RM e del 64,3%, 70,4%, 67,3%, 69,2% e 65,5% per il second-look ecografico. Con la valutazione dei soli potenziamenti di tipo nodulare si è ottenuto un miglioramento della capacità diagnostica dell’ecografia.

Conclusioni

Il second-look ecografico è un valido metodoper le lesioni occasionali alla RM della mammella, in particolar modo per i potenziamenti di tipo nodulare.

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References/Bibliografia

  1. Saslow D, Boetes C, Burke W et al (2007) American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography. CA Cancer J Clin 57:75–89

    Article  PubMed  Google Scholar 

  2. Sardanelli F, Giuseppetti GM, Canavese G et al (2008) Indications for breast magnetic resonance imaging. Consensus document “Attualità in senologia”, Florence 2007. Radiol Med 113:1085–1095

    Article  PubMed  CAS  Google Scholar 

  3. Hylton N (2005) Magnetic resonance imaging of the breast: opportunities to improve breast cancer management. J Clin Oncol 23:1678–1684

    Article  PubMed  Google Scholar 

  4. Pediconi F, Catalano C, Padula S et al (2007) Contrast-enhanced magnetic resonance mammography: does it affect surgical decision-making in patients with breast cancer? Breast Cancer Res Treat 106:65–74

    Article  PubMed  Google Scholar 

  5. Boetes C, Mus RDM, Holland R et al (1995) Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 197:743–747

    PubMed  CAS  Google Scholar 

  6. Rieber A, Merkle E, Böhm W et al (1997) MRI of histologically confirmed mammary carcinoma: clinical relevance of diagnostic procedures for detection of multifocal or contralateral secondary carcinoma. J Comput Assist Tomogr 21:773–779

    Article  PubMed  CAS  Google Scholar 

  7. Hata T, Takahashi H, Watanabe K et al (2004) Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography. J Am Coll Surg 198:190–197

    Article  PubMed  Google Scholar 

  8. Ikeda DM, Hylton NM, Kuhl CK et al (2003) Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. American College of Radiology, Reston

    Google Scholar 

  9. Pediconi F, Catalano C, Occhiato R et al (2005) Breast lesion detection and characterization at contrast-enhanced MR mammography: gadobenate dimeglumine versus gadopentetate dimeglumine. Radiology 237:45–56

    Article  PubMed  Google Scholar 

  10. Sardanelli F, Iozzelli A, Fausto A et al (2005) Gadobenate dimeglumine-enhanced MR imaging breast vascular maps: association between invasive cancer and ipsilateral increased vascularity. Radiology 235:791–797

    Article  PubMed  Google Scholar 

  11. Sardanelli F, Fausto A, Esseridou A et al (2008) Gadobenate dimeglumine as a contrast agent for dynamic breast magnetic resonance imaging: effect of higher initial enhancement thresholds on diagnostic performance. Invest Radiol 43:236–242

    Article  PubMed  CAS  Google Scholar 

  12. Pediconi F, Catalano C, Padula S et al (2008) Contrast-enhanced MR mammography: improved lesion detection and differentiation with gadobenate dimeglumine. AJR Am J Roentgenol 191:1339–1346

    Article  PubMed  Google Scholar 

  13. Orel SG (1999) Differentiating benign from malignant enhancing lesions identified at MR imaging of the breast: are time-signal intensity curves an accurate predictor? Radiology 211:5–7

    PubMed  CAS  Google Scholar 

  14. Kuhl CK, Mielcareck P, Klaschik S et al (1999) Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110

    PubMed  CAS  Google Scholar 

  15. Carbognin G, Calciolari C, Girardi V et al (2010) Inflammatory breast cancer: MR imaging findings. Radiol Med 115:70–82

    Article  PubMed  CAS  Google Scholar 

  16. Slanetz PJ, Edmister WB, Yeh ED et al (2002) Occult contralateral breast carcinoma incidentally detected by breast magnetic resonance imaging. Breast J 8:145–148

    Article  PubMed  Google Scholar 

  17. Lee SG, Orel SG, Woo IJ et al (2003) MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology 226:773–778

    Article  PubMed  Google Scholar 

  18. Viehweg P, Rotter K, Laniado M et al (2004) MR imaging of the contralateral breast in patients after breast-conserving therapy. Eur Radiol 14:402–408

    Article  PubMed  Google Scholar 

  19. 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

    PubMed  Google Scholar 

  20. Lehman CD, Blume JD, Thickman D et al (2005) Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol 92:9–15

    Article  PubMed  Google Scholar 

  21. Komatsu S, Lee CJ, Hosokawa Y et al (2005) A case of occult contralateral breast cancer incidentally detected by contrast-enhanced MRI; report of a case with review of literature. Breast Cancer 12:341–345

    Article  PubMed  Google Scholar 

  22. Pediconi F, Catalano C, Roselli A et al (2007) Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions. Radiology 243:670–680

    Article  PubMed  Google Scholar 

  23. Buchanan CL, Morris EA, Dorn PL et al (2005) Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol 12:1045–1053

    Article  PubMed  Google Scholar 

  24. Ko EY, Han BK, Shin JH, Kang SS (2007) Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography. Korean J Radiol 8:382–389

    Article  PubMed  Google Scholar 

  25. Lieberman S, Sella T, Maly B et al (2008) Breast magnetic resonance imaging characteristics in women with occult primary breast carcinoma. Isr Med Assoc J 10:448–452

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  27. 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 

  28. 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 17:51–57

    Article  PubMed  Google Scholar 

  29. Shin JH, Han BK, Choe YH et al (2007) Targeted ultrasound for MRdetected lesions in breast cancer patients. Korean J Radiol 8:475–483

    Article  PubMed  Google Scholar 

  30. Wiratkapun C, Duke D, Nordmann AS et al (2008) Indeterminate or suspicious breast lesions detected initially with MR imaging: value of MRIdirected breast ultrasound. Acad Radiol 15:618–625

    Article  PubMed  Google Scholar 

  31. 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 

  32. 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 

  33. Destounis S, Arieno A, Somerville PA et al (2009) Community-based practice experience of unsuspected breast magnetic resonance imaging abnormalities evaluated with secondlook sonography. J Ultrasound Med 28:1337–1346

    PubMed  Google Scholar 

  34. Kuhl CK, Morakkabati N, Leutner CC et al (2001) MR imaging-guided largecore (14-gauge) needle biopsy of small lesions visible at breast MR imaging alone. Radiology 220:31–39

    PubMed  CAS  Google Scholar 

  35. Morris EA, Liberman L, Dershaw DD et al (2002) Preoperative MR imaging-guided needle localization of breast lesions. AJR Am J Roentgenol 179:171–178

    PubMed  Google Scholar 

  36. Perretta T, Pistolese CA, Bolacchi F et al (2008) MR imaging-guided 10-gauge vacuum assisted breast biopsy: histological. Radiol Med 113:830–840

    Article  PubMed  CAS  Google Scholar 

  37. 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 15:1234–1245

    Article  Google Scholar 

  38. Van Goethem M, Schelfout K, Dijckmans L et al (2004) MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol 14:809–816

    Article  PubMed  Google Scholar 

  39. 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

    PubMed  Google Scholar 

  40. Schrading S, Kuhl CK (2008) Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology 246:58–70

    PubMed  Google Scholar 

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Correspondence to M. L. Luciani.

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Luciani, M.L., Pediconi, F., Telesca, M. et al. Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound. Radiol med 116, 886–904 (2011). https://doi.org/10.1007/s11547-011-0630-8

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  • DOI: https://doi.org/10.1007/s11547-011-0630-8

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