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Ultraschall Med 2015; 36(02): 140-148
DOI: 10.1055/s-0034-1399143
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Role of Second-Look Ultrasound Examinations for MR-Detected Lesions in Patients with Breast Cancer

Rolle der Second-Look-Sonografie bei Brustkrebs-Patienten mit Läsionen in der MRT
S. H. Lee
1   Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea, Republic of
,
S. M. Kim
2   Radiology, Seoul National University Bundang Hosipital, Seongnam, Korea, Republic of
,
M. Jang
2   Radiology, Seoul National University Bundang Hosipital, Seongnam, Korea, Republic of
,
B. L. Yun
2   Radiology, Seoul National University Bundang Hosipital, Seongnam, Korea, Republic of
,
E. Kang
3   Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea, Republic of
,
S. W. Kim
3   Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea, Republic of
,
S. Y. Park
4   Pathology, Seoul National University Bundang Hospital, Seongnam-si, Korea, Republic of
,
H. S. Ahn
5   Radiology, Chung-Ang University Hospital, Seoul, Korea, Republic of
,
J. H. Chang
6   Department of Electronic Engineering, Sogang University, Seoul, Korea, Republic of
,
Y. Yoo
6   Department of Electronic Engineering, Sogang University, Seoul, Korea, Republic of
,
T. K. Song
6   Department of Electronic Engineering, Sogang University, Seoul, Korea, Republic of
,
W. K. Moon
1   Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea, Republic of
› Author Affiliations
Further Information

Publication History

03 April 2014

22 January 2015

Publication Date:
06 March 2015 (online)

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Abstract

Purpose: To assess the clinical value of second-look ultrasound (US) examination for the evaluation of additional enhancing lesions detected on magnetic resonance (MR) imaging.

Materials and Methods: Between May 2008 and February 2011, 794 consecutive patients with histologically confirmed breast cancer underwent breast MR imaging. We included 101 patients with 132 additional enhancing breast lesions detected on MR imaging who underwent second-look US. The imaging features and lesion category according to the Breast Imaging and Reporting and Data System (BI-RADS) were assessed with MR and US imaging, respectively.

Results: According to the BI-RADS system, 67 lesions (50.8 %) were classified as category 0, 33 lesions (25.0 %) as category 3, and 32 lesions (24.2 %) as category 4. Of the 67 indeterminate lesions on MR imaging, 34 (50.7 %) were demonstrated on second-look US. 11 of these 34 lesions showed suspicious sonographic features, including 1 lesion that showed malignancy (9.1 %, 1/11). Most of the suspicious lesions on MR imaging (26 of 32 BI-RADS category 4 lesions, 81.3 %) were demonstrated on second-look US, and 17 were malignant (65.4 %, 17/26). Of the 6 BI-RADS category 4 lesions without sonographic correlation, 1 was malignant (16.7 %, 1/6).

Conclusion: Second-look US examination was useful for evaluating MR-detected lesions in patients with breast cancer.

Zusammenfassung

Ziel: Die Bestimmung des klinischen Nutzens der Second-Look-Sonografie (US) bei der Beurteilung von zusätzlichen Läsionen in der Magnetresonanztomografie (MRT).

Material und Methoden: Zwischen Mai 2008 und Februar 2011 wurde eine MRT-Untersuchung der Brust bei 794 aufeinander folgenden Patienten mit histologisch bestätigtem Brustkrebs durchgeführt. Wir schlossen 101 Patienten mit 132 zusätzlich mittels MRT entdeckten Brustläsionen ein, bei denen ein Second-Look-US durchgeführt wurde. Die Bildmerkmale und die Kategorie der Läsion gemäß des „Breast Imaging Reporting and Data System“ (BI-RADS) wurde jeweils mittels MRT und Sonografie bestimmt.

Ergebnisse: Nach dem BI-RADS-System wurden 67 Läsionen (50,8 %) in Kategorie 0, 33 Läsionen (25,0 %) in Kategorie 3 und 32 Läsionen (24,2 %) in Kategorie 4 eingeteilt. Von den 67 mittels MRT nicht definierbaren Läsionen wurden 34 (50,7 %) durch Second-Look-US nachgewiesen. Elf dieser 34 Läsionen zeigten auffällige sonografische Marker, einschließlich einer Läsion, die maligne war (9,1 %, 1/11). Die meisten der im MRT verdächtigen Läsionen (26 von 32 Läsionen der BI-RADS Kategorie 4, 81,3 %) wurden im Second-Look-US erkannt und 17 davon waren maligne (65,4 %, 17/26). Von den 6 Läsionen der BI-RADS Kategorie 4 ohne sonografische Korrelation war eine maligne (16,7 %, 1/6).

Schlussfolgerung: Die Second-Look Sonografie ist bei Brustkrebspatienten bei der Bewertung von Läsionen, die mittels MRT entdeckt wurden, von Nutzen.

Key words

breast cancer - ultrasound (US) - magnetic resonance imaging - MR-guided interventional procedures - ultrasonography - interventional
 

  • References

  • 1 Bluemke DA, Gatsonis CA, Chen MH et al. Magnetic resonance imaging of the breast prior to biopsy. JAMA: the journal of the American Medical Association 2004; 292: 2735-2742
    CrossrefPubMedGoogle Scholar
  • 2 Lee CH. Problem solving MR imaging of the breast. Radiologic clinics of North America 2004; 42: 919-34, vii
    CrossrefPubMedGoogle Scholar
  • 3 Liberman L. Breast MR imaging in assessing extent of disease. Magnetic resonance imaging clinics of North America 2006; 14: 339-349, vi
    CrossrefPubMedGoogle Scholar
  • 4 Schnall M. MR imaging evaluation of cancer extent: is there clinical relevance?. Magnetic resonance imaging clinics of North America 2006; 14: 379-381, vii
    CrossrefPubMedGoogle Scholar
  • 5 Smith RA. The evolving role of MRI in the detection and evaluation of breast cancer. The New England journal of medicine 2007; 356: 1362-1364
    CrossrefPubMedGoogle Scholar
  • 6 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. Am J Roentgenol American journal of roentgenology 2010; 194: 370-377
    PubMedGoogle Scholar
  • 7 Morris EA, Comstock C, Lee CH et al. ACR BI-RADS: Magnetic Resonance Imaging. Reston, VA: American College of Radiology; 2013
    Google Scholar
  • 8 Mahoney MC, Gatsonis C, Hanna L et al. Positive predictive value of BI-RADS MR imaging. Radiology 2012; 264: 51-58
    CrossrefPubMedGoogle Scholar
  • 9 Shin JH, Han BK, Choe YH et al. Targeted ultrasound for MR-detected lesions in breast cancer patients. Korean journal of radiology: official journal of the Korean Radiological Society 2007; 8: 475-483
    CrossrefPubMedGoogle Scholar
  • 10 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: 856-861
    CrossrefPubMedGoogle Scholar
  • 11 Morris EA. Diagnostic breast MR imaging: current status and future directions. Radiologic clinics of North America 2007; 45: 863-880, vii
    CrossrefPubMedGoogle Scholar
  • 12 Spick C, Baltzer PA. Diagnostic Utility of Second-Look US for Breast Lesions Identified at MR Imaging: Systematic Review and Meta-Analysis. Radiology 2014; [Epub ahead of print]
    PubMedGoogle Scholar
  • 13 Ko ES, Lee BH, Choi HY et al. Background enhancement in breast MR: correlation with breast density in mammography and background echotexture in ultrasound. European journal of radiology 2011; 80: 719-723
    CrossrefPubMedGoogle Scholar
  • 14 Houssami N, Ciatto S, Macaskill P et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2008; 26: 3248-3258
    CrossrefPubMedGoogle Scholar
  • 15 Solin LJ, Orel SG, Hwang WT et al. Relationship of breast magnetic resonance imaging to outcome after breast-conservation treatment with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ. J Clin Oncol 2008; 26: 386-391
    CrossrefPubMedGoogle Scholar
  • 16 Lee SG, Orel SG, Woo IJ et al. MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology 2003; 226: 773-778
    CrossrefPubMedGoogle Scholar
  • 17 Lehman CD, Gatsonis C, Kuhl CK et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. The New England journal of medicine 2007; 356: 1295-1303
    CrossrefPubMedGoogle Scholar
  • 18 Siva N. Using MRI to detect contralateral breast cancer. The lancet oncology 2007; 8: 377
    PubMedGoogle Scholar
  • 19 Macura KJ, Ouwerkerk R, Jacobs MA et al. Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics: a review publication of the Radiological Society of North America, Inc 2006; 26: 1719-1734 ; quiz
    CrossrefPubMedGoogle Scholar