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Utility of second-look ultrasound in the management of incidental enhancing lesions detected by breast MR imaging

Utilità del second look ecografico nel management delle lesioni incidentalmente identificate con RM della mammella

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

Abstract

Purpose

To assess the utility of second-look ultrasound (US) for identifying and characterising incidental enhancing lesions detected by breast magnetic resonance imaging (MRI).

Materials and methods

From among 655 consecutive breast MRI studies, 62 lesions (MRI visible, nonpalpable, occult at first-look US and mammography) were recommended for second-look US. MRI enhancement of lesions was mass-like in 59 cases (95%) and non-mass-like in three (5%). Forty-two lesions (68%) were ≤10 mm; only three lesions (5%) were >20 mm. Of all lesions, the Breast Imaging Reporting and Data System (BI-RADS) MRI category was highly suggestive of malignancy in six cases (10%), suspicious abnormality in 33 (53%) and probably benign in 23 (37%). The correlation between MRI lesion appearance, lesion size, histopathology findings and detection rate at second-look US were analysed. The reference standard was histopathology and/or follow-up (range 18–24 months). Statistical analysis was performed with the Fisher exact test.

Results

Second-look US identified 44 out of 62 (71%) lesions depicted at MRI. The detection rate at second-look US was higher for mass-like MRI lesions (75%) than nonmass-like lesions (0%), for lesion size >10mm (90%) and for BI-RADS 4 lesions (88%). Second-look US-guided biopsy detected 12 out of 17 (71%) malignant lesions. There was no correlation between the likelihood of carcinoma and the presence of a sonographic correlate.

Conclusions

Second-look US is a reliable problemsolving tool in identifying and characterising most incidental MRI findings. It contributes to accurately selecting the cases in which MRI-guided biopsy is required.

Riassunto

Obiettivo

Lo scopo del lavoro è stato verificare l’utilità del second look ecografico nella identificazione e nella tipizzazione delle lesioni incidentali alla risonanza magnetica (RM) mammaria.

Materiali e metodi

È stata effettuata un’analisi retrospettiva di 62 lesioni identificate incidentalmente dalla RM, non palpabili e occulte alla mammografia ed ecografia espletate prima della RM. L’impregnazione delle lesioni era tipo massa in 59 casi (95%) e non massa in 3 casi (5%). Quarantadue lesioni (68%) erano ≤10 mm; solo 3 lesioni (5%) erano >20 mm. Il grado di sospetto RM era alla classificazione breast imaging reporting and data system (BI-RADS) 5 in 6 casi (10%), BI-RADS 4 in 33 casi (53%), BI-RADS 3 in 23 casi (37%). Le lesioni RM con corrispettivo reperto al second look ecografico sono state analizzate riguardo: aspetto RM, dimensioni, sospetto radiologico, diagnosi istologica. Il gold standard è stato l’esame patologico o il follow-up clinico e strumentale a 24 mesi. I risultati sono stati analizzati con il test statistico di Fisher (significatività: p<0,05).

Risultati

Il second look ecografico ha identificato 44/62 (71%) lesioni incidentali alla RM mammaria. Il numero di lesioni identificate con il second-look è stato superiore in caso di impregnazione di tipo massa (75%), lesioni con dimensioni >10 mm (90%) e con BI-RADS 4 (88%). Dodici/44 (27%) lesioni identificate dal second look ecografico erano maligne e 5/18 (27%) lesioni prive di traduzione ecografica erano maligne. Il prelievo guidato dal second look ecografico ha caratterizato 12/17 (71%) lesioni maligne.

Conclusioni

Il second look ecografico è una valida metodica nel management delle lesioni identificate incidentalmente dalla RM mammaria in quanto consente l’identificazione e la caratterizzazione della maggioranza di esse e l’accurata selezione di quelle da avviare a procedure RM-guidate.

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Authors and Affiliations

  1. Istituto di Radiologia, Policlinico “G.B. Rossi”, P.le L.A. Scuro 10, 37134, Verona, Italy

    G. Carbognin, V. Girardi, C. Calciolari, A. Brandalise & A. Russo

  2. Dipartimento di Patologia, Policlinico “G.B. Rossi”, P.le L.A. Scuro 10, 37134, Verona, Italy

    F. Bonetti

Authors
  1. G. Carbognin
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  2. V. Girardi
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  3. C. Calciolari
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  4. A. Brandalise
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  5. F. Bonetti
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  6. A. Russo
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  7. R. Pozzi Mucelli
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Correspondence to V. Girardi.

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Carbognin, G., Girardi, V., Calciolari, C. et al. Utility of second-look ultrasound in the management of incidental enhancing lesions detected by breast MR imaging. Radiol med 115, 1234–1245 (2010). https://doi.org/10.1007/s11547-010-0561-9

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  • DOI: https://doi.org/10.1007/s11547-010-0561-9

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