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Ahmadinejad N, Azizinik F, Khosravi P, Torabi A, Mohajeri A, Arian A. Evaluation of Features in Probably Benign and Malignant Nonmass Enhancement in Breast MRI. Int J Breast Cancer 2024; 2024:6661849. [PMID: 38523651 PMCID: PMC10959584 DOI: 10.1155/2024/6661849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/08/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a highly sensitive breast imaging modality in detecting breast carcinoma. Nonmass enhancement (NME) is uniquely seen on MRI of the breast. The correlation between NME features and pathologic results has not been extensively explored. Our goal was to evaluate the characteristics of probably benign and suspicious NME lesions in MRI and determine which features are more associated with malignancy. We performed a retrospective research after approval by the hospital ethics committee on women who underwent breast MRI from March 2017 to March 2020 and identified 63 lesions of all 400 NME that were categorized as probably benign or suspicious according to the BI-RADS classification (version 2013). MRI features of NME findings including the location, size, distribution and enhancement pattern, kinetic curve, diffusion restriction, and also pathology result or 6-12-month follow-up MRI were evaluated and analyzed in each group (probably benign or suspicious NME). Vacuum-guided biopsies (VAB) were performed under mammographic or sonographic guidance and confirmed with MRI by visualization of the inserted clips. Segmental distribution and clustered ring internal enhancement were significantly associated with malignancy (p value<0.05), while linear distribution or homogeneous enhancement patterns were associated with benignity (p value <0.05). Additionally, the plateau and washout types in the dynamic curve were only seen in malignant lesions (p value <0.05). The presence of DWI restriction in NME lesions was also found to be a statistically important factor. Understanding the imaging findings of malignant NME is helpful to determine when biopsy is indicated. The correlation between NME features and pathologic results is critical in making appropriate management.
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Affiliation(s)
- Nasrin Ahmadinejad
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Azizinik
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini and Yas Hospital, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pershang Khosravi
- Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ala Torabi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arvin Arian
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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Leung JWT. Nonmass Descriptor at Breast US to Expand Clinical Utility. JOURNAL OF BREAST IMAGING 2024; 6:99-101. [PMID: 38150381 DOI: 10.1093/jbi/wbad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Jessica W T Leung
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Huang K, Dufresne M, Baksh M, Nussbaum S, Abbaszadeh Kasbi A, Mohammed A, Advani P, Morozov A, Bagaria S, McLaughlin S, Gabriel E. How Well Does Non-mass Enhancement Correlate With DCIS/Invasive Cancer? Am Surg 2023; 89:5414-5420. [PMID: 36788122 DOI: 10.1177/00031348231156776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Contiguous non-mass enhancement (NME) often coexists with a solid tumor component on MRI, but it can be challenging to predict whether NME represents invasive breast cancer, ductal carcinoma in situ (DCIS), benign disease, or biopsy site reaction. The purpose of this study was to determine the association between the size/extent of NME and the presence of invasive cancer and/or DCIS on final pathology. METHODS This was a single institution retrospective analysis of a prospectively maintained breast cancer registry (2010-2020). Female patients who underwent surgical resection were included if they had a diagnosis of invasive breast cancer (with or without DCIS) and had an MRI showing both a solid mass and contiguous NME. The size of NME on MRI was compared with the size of invasive cancer and/or DCIS on the final pathology. RESULTS From a total of 3443 patients, 225 patients were included. 86.2% had invasive ductal carcinoma (IDC), and 12.0% had invasive lobular carcinoma 76.9% were ER+, 16.4% were HER2+, and 13.3% were triple negative breast cancer (TNBC). 18.7% received neoadjuvant chemotherapy (NCT) of whom 31% achieved a complete radiographic/pathologic response. Pearson correlation coefficients (r) between the size of NME and invasive cancer/DCIS showed a strong and positive correlation of MRI NME with DCIS on pathology in patients without NCT. Subgroup analysis showed the strongest correlations for NME and DCIS among non-white (r = .70) and HER2 + patients (r = .74) who did not receive NCT. CONCLUSIONS Strong correlations between NME and DCIS were found for HER2 + disease and non-white patients, but only modest correlations were found for other patient/disease characteristics. These correlations may impact decisions in surgical approach.
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Affiliation(s)
- Kai Huang
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Maria Dufresne
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mizba Baksh
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Samuel Nussbaum
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Ashary Mohammed
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Pooja Advani
- Department of Hematology/Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrey Morozov
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sanjay Bagaria
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sarah McLaughlin
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Emmanuel Gabriel
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
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Wang T, Guo W, Zhang X, Ma J, Li F, Zheng S, Zhu M, Dong Y, Bai M. Correlation between conventional ultrasound features combined with contrast-enhanced ultrasound patterns and pathological prognostic factors in malignant non-mass breast lesions. Clin Hemorheol Microcirc 2023; 85:433-445. [PMID: 37781796 DOI: 10.3233/ch-231936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To investigate the correlation between ultrasound performance and prognostic factors in malignant non-mass breast lesions (NMLs). MATERIALS AND METHODS This study included 106 malignant NMLs in 104 patients. Different US features and contrast enhancement patterns were evaluated. Prognostic factors, including histological types and grades, axillary lymph node and peritumoral lymphovascular status, estrogen and progesterone receptor status and the expression of HER-2 and Ki-67 were determined. A chi-square test and logistic regression analysis were used to analyse possible associations. RESULTS Lesion size (OR: 3.08, p = 0.033) and posterior echo attenuation (OR: 8.38, p < 0.001) were useful in reflecting malignant NMLs containing an invasive carcinoma component. Posterior echo attenuation (OR: 7.51, p = 0.003) and unclear enhancement margin (OR: 6.50, p = 0.018) were often found in tumors with axillary lymph node metastases. Peritumoural lymphovascular invasion mostly exhibited posterior echo attenuation (OR: 3.84, p = 0.049) and unclear enhancement margin (OR: 8.68, p = 0.042) on ultrasound images. Perfusion defect was a comparatively accurate enhancement indicator for negative ER (OR: 2.57, p = 0.041) and PR (OR: 3.04, p = 0.008) expression. Calcifications (OR: 3.03, p = 0.025) and enlarged enhancement area (OR: 5.36, p = 0.033) imply an increased risk of positive HER-2 expression. Similarly, Calcifications (OR: 4.13, p = 0.003) and enlarged enhancement area (OR: 11.05, p < 0.001) were valid predictors of high Ki-67 proliferation index. CONCLUSION Ultrasound performance is valuable for non-invasive prediction of prognostic factors in malignant NMLs.
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Affiliation(s)
- Tong Wang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjuan Guo
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuemei Zhang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji Ma
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siqi Zheng
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Miao Zhu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Min Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Qi R, Fang J, Zhu L, Shan Y, Wang W, Xu C, Bao L. Prospective Evaluation of Ultrasound in a Novel Position with MRI Virtual Navigation for MRI-Detected Only Breast Lesions: A Pilot Study of a More Efficient and Economical Method. Diagnostics (Basel) 2022; 13:diagnostics13010029. [PMID: 36611321 PMCID: PMC9818998 DOI: 10.3390/diagnostics13010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to evaluate the clinical utility of ultrasound (US) with magnetic resonance imaging (MRI) virtual navigation in a novel prone position for MRI-detected incidental breast lesions. Between June 2016 and June 2020, 30 consecutive patients with 33 additional Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 lesions that were detected on MRI but occult on second-look US were enrolled in the study. All suspicious lesions were located in real-time US using MRI virtual navigation in the prone position and then followed by US-guided biopsy or surgical excision. Pathological results were taken as the standard of reference. The detection rate of US with MRI virtual navigation was calculated. The MRI features and pathological types of these lesions were analyzed. A total of 31 lesions were successfully located with real-time US with MRI virtual navigation and then US-guided biopsy or localization, and the detection rate was 93.9% (31/33). Twenty-seven (87.1%, 27/31) proved to be benign lesions and four (12.9%, 4/31) were malignant lesions at pathology. Of the 33 MRI-detected lesions, 31 (93.9%, 31/33) were non-mass enhancements and two (6.1%, 2/33) were masses. This study showed that real-time US with prone MRI virtual navigation is a novel efficient and economical method to improve the detection and US-guided biopsy rate of breast lesions that are detected solely on MRI.
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Affiliation(s)
- Ruixiang Qi
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Jianhua Fang
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Luoxi Zhu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Yanna Shan
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Wei Wang
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Chenke Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Lingyun Bao
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
- Correspondence:
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Armani M, Lissavarid É, Dyien B, Manceau J, Bereby Kahane M, Malhaire C, Tardivon A. Lésions classées ACR3 en IRM mammaire. IMAGERIE DE LA FEMME 2022. [DOI: 10.1016/j.femme.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Coskun Bilge A, Demir PI, Aydin H, Bostanci IE. Dynamic contrast-enhanced breast magnetic resonance imaging findings that affect the magnetic resonance-directed ultrasound correlation of non-mass enhancement lesions: a single-center retrospective study. Br J Radiol 2022; 95:20210832. [PMID: 34990263 PMCID: PMC9153717 DOI: 10.1259/bjr.20210832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Our single-center retrospective study aimed to evaluate the relationship between magnetic resonance (MR)-directed ultrasound (MDUS) detectability and MRI findings of non-mass enhancement (NME) lesions, regarding the morphologic and enhancement features, the distance from the skin and nipple, and the presence of concomitant landmarks. METHODS A total of 350 MRI-detected NME lesions that were determined between January 2015 and May 2019 and subsequently underwent MDUS were analyzed. The MRI findings, biopsy results, and follow-up outcomes of lesions were recorded. The correlation between the MRI findings of the lesions and MDUS detectability was analyzed. RESULTS 114 (32.6%) of the 350 lesions had a counterpart in the MDUS. Respectively, 66 (37.9%), 38 (43.2%) and 59 (38.3%) of the lesions detected in MDUS were larger than 20 mm in size, with a distance of less than 20 mm to the nipple and 15 mm to the skin. The lesion size and lesion distance to the nipple and skin were significantly associated with a ultrasound correlate (p < 0.05). The MDUS detection rate was significantly higher in NME lesions with MR findings including diffuse distribution (p < 0.001), clustered-ring enhancement pattern (p < 0.001), washout kinetic curve (p = 0.006), and MR-BIRADS category 5 (p < 0.001). Multivariate logistic regression showed that only the clustered-ring enhancement pattern was significantly associated with an MDUS correlation (p < 0.001). CONCLUSION Statistically significant correlations were found between the size, distance to the nipple and skin, distribution pattern, enhancement pattern and kinetic curve of the NME lesions on MRI and ultrasound detectability. ADVANCES IN KNOWLEDGE We found that clustered-ring enhancement patterns were significantly more frequent in MR-directed ultrasound detectable lesions.
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Affiliation(s)
- Almila Coskun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Pinar Ilhan Demir
- Department of Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hale Aydin
- Department of Radiology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Isil Esen Bostanci
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Goto M, Nakano S, Saito M, Banno H, Ito Y, Ido M, Ando T, Kousaka J, Fujii K, Suzuki K. 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 Ultrason (2001) 2022; 49:269-278. [PMID: 35083535 DOI: 10.1007/s10396-021-01175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/08/2021] [Indexed: 12/01/2022]
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.
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Affiliation(s)
- Manami Goto
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Shogo Nakano
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan.
| | - Masayuki Saito
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Hirona Banno
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Yukie Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Mirai Ido
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Takahito Ando
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Junko Kousaka
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Kimihito Fujii
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
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Price J. 12-year review of MRI-detected breast cancers. How often was a diagnosis of malignancy established using targeted ultrasound and standard 14-gauge core biopsy? J Med Imaging Radiat Oncol 2021; 66:738-748. [PMID: 34837348 DOI: 10.1111/1754-9485.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This retrospective study aimed to determine the percentage of MRI-detected breast cancers diagnosed using targeted ultrasound and standard 14-gauge (14g) biopsy in the setting of an Australian breast MRI service. This is of clinical relevance because malignancies not identifiable on mammography or by ultrasound may then require more invasive, technically demanding and costly MRI-guided interventional procedures, usually by large-core vacuum-assisted biopsy (VAB) or hook-wire localisation with open surgical biopsy. METHODS On review of the 12-year period 2006-2018, we identified 67 new breast cancer events in 64 women where the diagnosis was made on the basis of the MRI scan findings either alone (n = 60) or in combination with a concurrent mammogram (n = 7), with no recorded clinical abnormality. The percentage in which malignancy was confirmed on histopathology using targeted ultrasound in combination with 14g biopsy was determined versus other biopsy methods, for both invasive cancer and in situ disease. RESULTS Ultrasound-guided 14g biopsy was successful in establishing the presence of malignancy in 42/46 (91%) of events with a final diagnosis of invasive cancer, with 2 more proven by MRI-guided interventional procedures (1 VAB and 1 hook-wire) and 1 by open surgical biopsy. In the final case, a 5 mm focus on MRI with no sonographic correlate at the initial presentation was only identified and biopsied by ultrasound at 12-month follow-up. For events with a final diagnosis of DCIS/pLCIS (pleomorphic LCIS, n = 2), US-guided 14g biopsy was successful in 10/21 (48%), while 4/7 events with corresponding mammographic microcalcifications were proven by x-ray stereotactic interventions. A further 5 events had MRI-guided interventions (3 VAB and 2 hook-wires) and 1 an open surgical biopsy to confirm malignancy. In the final case (a woman with a 30 × 20 mm focal area of non-mass enhancement with corresponding microcalcifications consistent with DCIS), a pathologic diagnosis was not made until the patient presented 5 years later with invasive disease. There were also 3 instances of upgrades to invasion on final surgical pathology, one from pLCIS to microinvasion and 2 others from DCIS to IDC. Among the DCIS/pLCIS events, semi-random 14g core biopsy (sampling at the expected location of the MRI abnormality without a specific sonographic correlate) proved to be successful in 3 women. CONCLUSION Ultrasound-guided 14g core biopsy established a malignant diagnosis in 91% of invasive cancers and in 48% of DCIS/pLCIS cases. This relatively non-invasive, technically easy to perform and low-cost biopsy procedure can be used immediately when targeted ultrasound shows a correlate for a suspicious MRI scan finding. Careful imaging-pathologic correlation is required after 14g biopsy, and a discordant result will usually prompt recourse to an MRI-guided VAB or hook-wire localisation.
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Affiliation(s)
- Jeremy Price
- Qscan Radiology Clinics, Kingston, Australian Capital Territory, Australia
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Bartels AK, Fadare O, Hasteh F, Zare SY. Nonmass enhancement lesions of the breast on core needle biopsy: outcomes, frequency of malignancy, and pathologic findings. Hum Pathol 2021; 111:92-97. [PMID: 33722650 DOI: 10.1016/j.humpath.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
Nonmass enhancement (NME) on breast magnetic resonance imaging (MRI) is defined as an area whose internal enhancement characteristics can be distinguished from the normal surrounding breast parenchyma, without an associated mass in the Breast Imaging Reporting and Data System lexicon. In this study, we evaluated the pathologic correlates of NME lesions of the breast identified on MRI at our institution, including the frequency of atypical or malignant lesions in the core needle biopsies (CNBs), performed after such a radiologic finding. A retrospective study was performed on all CNBs performed for NME on breast MRI between 2010 and 2019. A total of 443 biopsies from 411 patients were identified, comprising 5.5% of all CNBs over the study period. The pathologic diagnoses were benign in the majority of the biopsies (68.0%), whereas 11.5% and 20.5% of the cases were atypical and malignant lesions, respectively. Of the malignant cases, 69.2% were ductal carcinoma in situ (DCIS) and 30.8% were invasive carcinomas. The most common invasive cancer was invasive ductal carcinoma (50%), followed by invasive lobular carcinoma (39.3%). NME identified on breast MRI carried a significant (32%) risk of atypia and malignancy in our cohort, which confirms that biopsy evaluation of these lesions is warranted. DCIS was the most commonly identified malignancy. Notably, among invasive cancers, invasive lobular carcinoma was identified at a substantially higher frequency that would be expected for that histotype.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Large-Core Needle
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/pathology
- Female
- Humans
- Magnetic Resonance Imaging
- Middle Aged
- Retrospective Studies
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Affiliation(s)
- Anne K Bartels
- Department of Pathology, University of California San Diego, La Jolla, CA, 92037, United States
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego, La Jolla, CA, 92037, United States
| | - Farnaz Hasteh
- Department of Pathology, University of California San Diego, La Jolla, CA, 92037, United States
| | - Somaye Y Zare
- Department of Pathology, University of California San Diego, La Jolla, CA, 92037, United States.
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Torous VF, Resteghini NA, Phillips J, Dialani V, Slanetz PJ, Schnitt SJ, Baker GM. Histopathologic Correlates of Nonmass Enhancement Detected by Breast Magnetic Resonance Imaging. Arch Pathol Lab Med 2021; 145:1264-1269. [PMID: 33450753 DOI: 10.5858/arpa.2020-0266-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Dynamic, contrast-enhanced magnetic resonance imaging (MRI) is a highly sensitive imaging modality used for screening and diagnostic purposes. Nonmass enhancement (NME) is commonly seen on MRI of the breast. However, the pathologic correlates of NME have not been extensively explored. Consequently, concordance between MRI and pathologic findings in such cases may be uncertain and this uncertainty may cause the need for additional procedures. OBJECTIVE.— To examine the histologic alterations that correspond to NME on MRI. DESIGN.— We performed a retrospective search for women who underwent breast MRI between March 2014 and December 2016 and identified 130 NME lesions resulting in biopsy. The MRI findings and pathology slides for all cases were reviewed. The follow-up findings on any subsequent excisions were also noted. RESULTS.— Among the 130 cases, the core needle biopsy showed 1 or more benign lesions without atypia in 80 cases (62%), atypical lesions in 21 (16%), ductal carcinoma in situ in 22 (17%), and invasive carcinoma in 7 (5%). Review of the imaging features demonstrated some statistically significant differences in lesions that corresponded to malignant lesions as compared with benign alterations, including homogeneous or clumped internal enhancement, type 3 kinetics, and T2 dark signal; however, there was considerable overlap of features between benign and malignant lesions overall. Of 130 cases, 54 (41.5%) underwent subsequent excision with only 6 cases showing a worse lesion on excision. CONCLUSIONS.— This study illustrates that NME can be associated with benign, atypical, and/or malignant pathology and biopsy remains indicated given the overlap of radiologic features.
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Affiliation(s)
- Vanda F Torous
- From the Department of Pathology, Massachusetts General Hospital, Boston (Torous)
| | - Nancy A Resteghini
- Department of Radiology, Atrius Health, Boston, Massachusetts (Resteghini)
| | | | | | - Priscilla J Slanetz
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts (Slanetz)
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (Schnitt)
| | - Gabrielle M Baker
- Pathology (Baker), Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Kwon BR, Chang JM, Kim SY, Lee SH, Shin SU, Yi A, Cho N, Moon WK. Utility and Diagnostic Performance of Automated Breast Ultrasound System in Evaluating Pure Non-Mass Enhancement on Breast Magnetic Resonance Imaging. Korean J Radiol 2020; 21:1210-1219. [PMID: 32729267 PMCID: PMC7462763 DOI: 10.3348/kjr.2019.0881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/11/2020] [Accepted: 03/29/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the utility and diagnostic performance of automated breast ultrasound system (ABUS) with that of hand-held ultrasound (HHUS) in evaluating pure non-mass enhancement (NME) lesions on breast magnetic resonance imaging (MRI). Materials and Methods One hundred twenty-six consecutive MRI-visible pure NME lesions of 122 patients with breast cancer were assessed from April 2016 to March 2017. Two radiologists reviewed the preoperative breast MRI, ABUS, and HHUS images along with mammography (MG) findings. The NME correlation rate and diagnostic performance of ABUS were compared with that of HHUS, and the imaging features associated with ABUS visibility were analyzed. Results Among 126 pure NME lesions, 100 (79.4%) were malignant and 26 (20.6%) were benign. The overall correlation rate was 87.3% (110/126) in ABUS and 92.9% (117/126) in HHUS. The sensitivity and specificity were 87% and 50% for ABUS and 92% and 42.3% for HHUS, respectively, with no significant differences (p = 0.180 and 0.727, respectively). Malignant NME was more frequently visualized than benign NME lesions on ABUS (93% vs. 65.4%, p = 0.001). Significant factors associated with the visibility of ABUS were the size of NME lesions on MRI (p < 0.001), their distribution pattern (p < 0.001), and microcalcifications on MG (p = 0.027). Conclusion ABUS evaluation of pure NME lesions on MRI in patients with breast cancer is a useful technique with high visibility, especially in malignant lesions. The diagnostic performance of ABUS was comparable with that of conventional HHUS in evaluating NME lesions.
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Affiliation(s)
- Bo Ra Kwon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Soo Yeon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Ui Shin
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Ann Yi
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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13
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Kolta M, Clauser P, Kapetas P, Bernathova M, Pinker K, Helbich TH, Baltzer PAT. Can second-look ultrasound downgrade MRI-detected lesions? A retrospective study. Eur J Radiol 2020; 127:108976. [PMID: 32339982 DOI: 10.1016/j.ejrad.2020.108976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine whether MRI-detected suspicious (BIRADS 4 & 5) breast lesions can be downgraded using second-look ultrasound (SLU) and thus reduce unnecessarily performed breast biopsies. MATERIALS METHODS A retrospective single-center review of consecutive patients, who underwent breast MRI studies during a 12-month time period was performed. 94 patients with 103 lesions undergoing SLU of incidentally detected MRI BI-RADS 4&5 lesions which were not identified on previous ultrasound were included in the study. The SLU detection rate and SLU features of the lesions were assessed. Histology (91/103) or two year follow up (n = 12) were defined as the reference standard for lesion diagnosis. RESULTS 57 (55.3 %) of the 103 lesions were identified on SLU. 17 of the identified lesions were malignant (29.8 %). Lesions detected on ultrasound presented on MRI as masses in 66.7 % (38/57) and non-mass in 33.3 % (19/57). Our findings showed that it is possible to distinguish between malignant and benign lesions with SLU. The results were significant (p < 0.05) for the following morphological features: shape, orientation, margins, architectural distortion, hyperechoic rim/ edema. All lesions classified as SLU BI-RADS 2 in our study were benign and thus, 30 % of all unnecessary biopsies could potentially have been avoided. Including SLU BI-RADS 3 lesions, this rate increased to 60 %, while yielding one (of 17, 5.8 %) false negative result. All three BI-RADS 5 lesions detected by SLU presented as malignant on ultrasound. CONCLUSION SLU can potentially downgrade incidental MRI BIRADS 4 lesions. This may reduce the number of unnecessarily performed biopsies by 30-60 %, thus simplifying patient management.
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Affiliation(s)
- Michael Kolta
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria; Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria.
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14
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Abstract
OBJECTIVE. The purpose of this article is to review the literature regarding image-guided breast procedures, including helpful tips and tricks to guide the practicing interventional breast radiologist. CONCLUSION. The successful diagnosis and treatment of breast cancer involves coordination of the multidisciplinary breast team. Optimal procedural skills for image-guided biopsy and preoperative lesion localization are paramount to the radiologists' success.
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15
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Yalnız C, Rosenblat J, Spak D, Wei W, Scoggins M, Le-Petross C, Dryden MJ, Adrada B, Doğan BE. Association of Retrospective Peer Review and Positive Predictive Value of Magnetic Resonance Imaging-Guided Vacuum-Assisted Needle Biopsies of Breast. Eur J Breast Health 2019; 15:229-234. [PMID: 31620681 DOI: 10.5152/ejbh.2019.5002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/30/2019] [Indexed: 12/17/2022]
Abstract
Objective To evaluate the association between retrospective peer review of breast magnetic resonance imaging-guided vacuum-assisted needle biopsies and positive predictive value of subsequent magnetic resonance imaging-guided biopsies. Materials and Methods In January, 2015, a weekly conference was initiated in our institution to evaluate all breast magnetic resonance imaging-guided vacuum-assisted needle biopsies performed over January 1, 2014-December 31, 2015. During this weekly conferences, breast dynamic contrast-enhanced magnetic resonance imaging findings of 6 anonymized cases were discussed and then the faculty voted on whether they agree with the biopsy indication, accurate sampling and radiology-pathology correlation. We retrospectively reviewed and compared the magnetic resonance imaging indication, benign or malignant pathology rates, lesion types and the positive predictive value of magnetic resonance imaging-guided vacuum-assisted needle biopsy in the years before and after initiating this group peer review. Results The number of dynamic contrast-enhanced magnetic resonance imaging and magnetic resonance imaging-guided vacuum-assisted needle biopsies before and after initiating the review were 1447 vs 1596 (p=0.0002), and 253 (17.5%) vs 203 (12.7%) (p=0.04), respectively. There was a significant decrease in the number of benign biopsies in 2015 (n=104) compared to 2014 (n=154, p=0.04). The positive predictive value of magnetic resonance imaging-guided biopsy significantly increased after group review was implemented (Positive predictive value in 2014=%39.1 and positive predictive value in 2015=%48.8) (p=0.03), although the indications (p=0.49), history of breast cancer (p=0.14), biopsied magnetic resonance imaging lesion types (p=0.53) were not different. Less surgical excision was performed on magnetic resonance imaging-guided vacuum-assisted needle biopsy identified high-risk lesions in 2015 (p=0.25). Conclusion Our study showed an association between retrospective peer review of past biopsies and increased positive predictive value of magnetic resonance imaging-guided vacuum-assisted needle biopsies in our institution.
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Affiliation(s)
- Ceren Yalnız
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Juliana Rosenblat
- Department of Diagnostic Radiology, Memorial Healthcare System, Hollywood, FL, USA
| | - David Spak
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Wei Wei
- Taussig Cancer Institute Cleveland Clinic, Biostatistics, Cleveland, OH, USA
| | - Marion Scoggins
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Carisa Le-Petross
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Mark J Dryden
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Beatriz Adrada
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Başak E Doğan
- Department of Radiology, Division of Breast Imaging, University of Texas Southwestern Medical Center, Dallas, TX, USA
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16
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Izumori A, Kokubu Y, Sato K, Gomi N, Morizono H, Sakai T, Horii R, Akiyama F, Iwase T, Ohno S. Usefulness of second-look ultrasonography using anatomical breast structures as indicators for magnetic resonance imaging-detected breast abnormalities. Breast Cancer 2019; 27:129-139. [PMID: 31407151 PMCID: PMC6954142 DOI: 10.1007/s12282-019-01003-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/07/2019] [Indexed: 11/29/2022]
Abstract
Background Second-look ultrasonography (US) is commonly performed for breast lesions detected using magnetic resonance imaging (MRI), but the identification rate of these lesions remains low. We investigated if US methods using anatomical breast structures can improve the lesion identification rate of MR-detected lesions and evaluated the diagnostic performance of fine-needle aspiration cytology (FNAC) of the second-look US using the above-mentioned method. Methods We retrospectively assessed 235 breast lesions (hereinafter, “targets”) subjected to second-look US following MRI between January 2013 and September 2015. US was employed using the conventional methods, and this assessment measured the positional relationships of lesions with regard to surrounding anatomical breast structures (glandular pattern, Cooper’s ligaments, adipose morphology, and vascular routes). Associations were assessed among the following variables: the MRI findings, target size, identification rate, and main US indicators that led to identifying the target; FNAC results and MRI findings; MRI findings and histopathological findings; and FNAC results and histopathological findings. Moreover, the sensitivity and specificity of FNAC were determined. Results The identification rate was 99%. The main US indicators leading to identification were a glandular pattern (28–30% of lesions) and other breast structures (~ 25% of lesions). FNAC was performed for 232 targets with the following results: sensitivity of 85.7%, specificity of 91.6%, PPV of 94.1%, NPV of 92.9%, false-negative rate of 14.3%, false-positive rate of 2.1%, and accuracy of 89.7%. Conclusions Second-look US using anatomical breast structures as indicators and US-guided FNAC are useful for refining the diagnosis of suspicious breast lesions detected using MRI.
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Affiliation(s)
- Ayumi Izumori
- Department of Breast Surgery, Takamatsu Heiwa Hospital, Takamatsu, Japan.
| | - Yumi Kokubu
- Department of Diagnostic Imaging, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Ultrasound, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuko Sato
- Department of Ultrasound, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoya Gomi
- Department of Diagnostic Imaging, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetomo Morizono
- Department of Cytology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takehiko Sakai
- Department of Cytology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Horii
- Department of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Futoshi Akiyama
- Department of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuji Iwase
- Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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17
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Ando T, Ito Y, Ido M, Osawa M, Kousaka J, Mouri Y, Fujii K, Nakano S, Kimura J, Ishiguchi T, Watanebe R, Imai T, Fukutomi T. 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 IN MEDICINE & BIOLOGY 2018; 44:1364-1370. [PMID: 29653774 DOI: 10.1016/j.ultrasmedbio.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/12/2018] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this retrospective study was to evaluate the effect of pre-operative planning using real-time virtual sonography (RVS), a magnetic resonance imaging (MRI)/ultrasound (US) image fusion technique on breast-conserving surgery (BCS) in patients with non-mass enhancement (NME) on breast MRI. Between 2011 and 2015, we enrolled 12 consecutive patients who had lesions with NME that exceeded the US hypo-echoic area, in which it was particularly difficult to evaluate the tumor margin. During pre-operative planning before breast-conserving surgery, RVS was used to delineate the enhancing area on the breast surface after additional supine breast MRI was performed. We analyzed both the surgical margin positivity rate and the re-operation rate. All NME lesions corresponded to the index cancer. In all patients, the diameter of the NME lesion was greater than that of the hypo-echoic lesion. The median diameters of the NME and hypo-echoic lesions were 24 mm (range: 12-39 mm) and 8.0 mm (range: 4.9-18 mm), respectively (p = 0.0002). After RVS-derived skin marking was performed on the surface of the affected breast, lumpectomy and quadrantectomy were conducted in 7 and 5 patients, respectively. The surgical margins were negative in 10 (83%) patients. Two patients with positive margins were found to have ductal carcinoma in situ in 1 duct each, 2.4 and 3.2 mm from the resection margin, respectively. None of the patients required additional resection. Although further prospective studies are required, the findings of our preliminary study suggest that it is very well possible that the use of RVS-derived skin marking during pre-operative planning for BCS in patients with NME would have resulted in surgical outcomes similar to or better than those obtained without the use of such marking.
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Affiliation(s)
- Takahito Ando
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Yukie Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Mirai Ido
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Manami Osawa
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Junko Kousaka
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Yukako Mouri
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Kimihito Fujii
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Shogo Nakano
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute City, Aichi, Japan.
| | - Junko Kimura
- Department of Radiology, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Rie Watanebe
- Department of Breast Surgery, Yodogawa Christian Hospital, Higashi Yodogawa Ku, Osaka, Japan
| | - Tsuneo Imai
- Department of Breast and Endocrine Surgery, Higashinagoya National Hospital, Meitou Ku, Aichi, Japan
| | - Takashi Fukutomi
- Department of Breast Surgery, Tokyo Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
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18
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Sonographic-MRI Correlation After Percutaneous Sampling of Targeted Breast Ultrasound Lesions: Initial Experiences With Limited-Sequence Unenhanced MRI for Postprocedural Clip Localization. AJR Am J Roentgenol 2018; 210:927-934. [DOI: 10.2214/ajr.17.18489] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Watanabe R, Ando T, Osawa M, Ido M, Kousaka J, Mouri Y, Fujii K, Nakano S, Kimura J, Ishiguchi T, Yoshida M, Imai T, Fukutomi T. Second-look US Using Real-time Virtual Sonography, a Coordinated Breast US and MRI System with Electromagnetic Tracking Technology: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2362-2371. [PMID: 28666549 DOI: 10.1016/j.ultrasmedbio.2017.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
Our aim was to retrospectively evaluate the utility of second-look ultrasound (US) using real-time virtual sonography (RVS) for detection of conventional B-mode (cB-mode) occult magnetic resonance imaging (MRI)-detected breast lesions. Between July 2011 and May 2015, 53 consecutive patients who underwent second-look US to identify lesions detected by prone MRI were enrolled in this study. Second-look US using RVS was performed for cB-mode occult MRI-detected breast lesions after an additional supine MRI. In the 53 patients, 59 lesions were initially detected by prone MRI, followed by second-look US. Of the 59 lesions, 20 (34%) were identified by second-look US using cB-mode. Of the 39 (66%) cB-mode occult lesions, 38 (97%) were detected in supine MRI and 33 (85%) were detected by second-look US using RVS. MRI morphology types of the 33 lesions were as follows: mass, 16; non-mass enhancement, 5; and focus, 12. US-guided biopsy under RVS or excisional biopsy demonstrated that of the 33 lesions, 8 (24%) were malignant and the remaining 25 (76%) were benign. A total of 53 (90%) MRI-detected lesions were sonographically identified using both cB-mode and RVS (p < 0.001). All five remaining US-occult lesions could be followed up under RVS after the enhancing area was marked on the breast surface using RVS. Although further prospective studies are required, the findings of our pilot study suggest that second-look US using RVS with additional supine MRI may improve the sonographic and histopathologic detection rate of cB-mode occult MRI-detected breast lesions.
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Affiliation(s)
- Rie Watanabe
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan; Department of Breast Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Takahito Ando
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Manami Osawa
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Mirai Ido
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Junko Kousaka
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Yukako Mouri
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Kimihito Fujii
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Shogo Nakano
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan.
| | - Junko Kimura
- Department of Radiology, Aichi Medical University, Nagakute, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, Nagakute, Japan
| | - Miwa Yoshida
- Department of Breast Surgical Oncology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Tsuneo Imai
- Department of Breast and Endocrine Surgery, Higashinagoya National Hospital, Nagoya, Japan
| | - Takashi Fukutomi
- Department of Breast Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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20
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Newburg AR, Chhor CM, Young Lin LL, Heller SL, Gillman J, Toth HK, Moy L. Magnetic Resonance Imaging-Directed Ultrasound Imaging of Non-Mass Enhancement in the Breast: Outcomes and Frequency of Malignancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:493-504. [PMID: 28108994 DOI: 10.7863/ultra.16.03001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study was performed to determine the frequency, predictors, and outcomes of ultrasound (US) correlates for non-mass enhancement. METHODS From January 2005 to December 2011, a retrospective review of 5837 consecutive breast magnetic resonance imaging examinations at our institution identified 918 non-mass enhancing lesions for which follow-up or biopsy was recommended. Retrospective review of the images identified 879 of 918 lesions (96%) meeting criteria for non-mass enhancement. Patient demographics, pathologic results, and the presence of an adjacent landmark were recorded. Targeted US examinations were recommended for 331 of 879 cases (38%), and 284 of 331 women (86%) underwent US evaluations. RESULTS The US correlate rate for non-mass enhancement was 23% (64 of 284). An adjacent landmark was significantly associated with a US correlate (P < .001). Biopsy was recommended for 43 of 64 correlates (67%). Ultrasound-guided biopsy was performed on 39 of 43 (91%); 7 of 39 (18%) were malignant. No correlate was seen for 220 of 284 lesions (77%). At magnetic resonance imaging-guided biopsy, 14 of 117 (12%) were malignancies. For all biopsied non-mass enhancements, the malignancy rate was 18% (55 of 308) and was significantly more prevalent in the setting of a known index cancer (P < .001), older age (P < .001), the presence of a landmark (P = .002), and larger lesion size (P = .019). CONCLUSIONS Non-mass enhancement with an adjacent landmark is more likely to have a US correlate compared to non-mass enhancement without an adjacent landmark. Non-mass enhancement in the setting of a known index cancer, older age, a landmark, and larger lesion size is more likely to be malignant. However, no statistical difference was detected in the rate of malignancy between non-mass enhancement with (18%) or without (12%) a correlate. Absence of a correlate does not obviate the need to biopsy suspicious non-mass enhancement.
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Affiliation(s)
- Adrienne R Newburg
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chloe M Chhor
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Leng Leng Young Lin
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Samantha L Heller
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Jennifer Gillman
- Department of Internal Medicine, Lenox Hill Hospital, New York, New York, USA
| | - Hildegard K Toth
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Linda Moy
- Department of Radiology, New York University School of Medicine, New York, New York, USA
- Department of Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, New York, USA
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