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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:
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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.


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.


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



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.


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.


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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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).

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