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

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

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