Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria.
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.
Eur J Radiol. 2020 Jun;127:108976. doi: 10.1016/j.ejrad.2020.108976. Epub 2020 Apr 11.
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.
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.
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.
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.
确定磁共振成像（MRI）检测到的可疑（BI-RADS 4 和 5）乳腺病变是否可以通过二次超声检查（SLU）降级，从而减少不必要的乳腺活检。
对 12 个月内进行乳腺 MRI 研究的连续患者进行回顾性单中心研究。对 94 例患者的 103 个病变进行了 SLU 检查，这些病变是在之前的超声检查中未发现的 MRI BI-RADS 4&5 病变。评估了 SLU 的检出率和病变的 SLU 特征。组织学（91/103）或两年随访（n=12）被定义为病变诊断的参考标准。
103 个病变中有 57 个（55.3%）在 SLU 中被识别。在已识别的病变中，有 17 个为恶性（29.8%）。在超声检查中发现的病变在 MRI 上表现为肿块 66.7%（38/57）和非肿块 33.3%（19/57）。我们的研究结果表明，SLU 可以区分良恶性病变。对于以下形态学特征，结果具有统计学意义（p<0.05）：形状、方位、边界、结构扭曲、高回声边缘/水肿。在我们的研究中，所有分类为 SLU BI-RADS 2 的病变均为良性，因此，30%的不必要活检可以避免。包括 SLU BI-RADS 3 病变在内，这一比例增加到 60%，同时产生一个（17 个中的 1 个，5.8%）假阴性结果。SLU 检测到的所有 3 个 BI-RADS 5 病变在超声检查中均表现为恶性。
SLU 可能会使偶然发现的 MRI BI-RADS 4 病变降级。这可能会减少 30-60%的不必要活检，从而简化患者管理。
