Ma Li, Qin Jing, Kong Lingyan, Zhao Jialin, Xiao Mengsu, Wang Hongyan, Zhang Jing, Jiang Yuxin, Li Jianchu, Liu He, Zhu Qingli
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Front Oncol. 2022 May 31;12:901757. doi: 10.3389/fonc.2022.901757. eCollection 2022.
Interpretation discrepancy is a major disadvantage of breast imaging. This study aimed to determine the clinical benefit of the pre-biopsy second-look breast ultrasound (US).
Patients with suspicious breast masses referred to our tertiary hospital for US-guided breast biopsy were retrospectively reviewed between August 2017 and November 2019. Here, second-look assessments were performed by experienced specialized breast radiologists performing a bilateral breast US scan plus reviewing former imaging studies, and results were compared with the initial assessment. Interpretation changes in terms of biopsy recommendation and surgical management (i.e., lumpectomy to mastectomy) were analyzed.
A total of 537 patients were enrolled in this study. Interpretation discrepancies occurred in 109 patients (20%; 95% CI, 17%-24%). Among them, there were 84 patients (16%; 95% CI, 13%-19%) whose masses were re-classified as BI-RADS 3 by the second-look US and underwent 2-year follow-up, showing 82 benign, 1 malignant, and 1 high-risk lesions. On the other hand, 16 patients (3%; 95% CI, 2%-5%) undertook biopsy at an additional site, identifying 10 new malignant lesions, 3 high-risk lesions, and 3 benign lesions, resulting in surgical management changes in 12 patients. In addition, nine (2%; 95% CI, 1%-3%) patients received discrepant disease ranges, which also altered surgical management. Overall, 21 patients (4%; 95% CI, 3%-6%) got their surgical management altered by the second-look US.
Pre-biopsy second-look assessment of breast US can reduce unnecessary biopsies in 16% of patients and alter surgical management in 4% of patients, suggesting it is a practical and valuable method for patient care improvement.
解读差异是乳腺影像学检查的一个主要缺点。本研究旨在确定活检前二次乳腺超声（US）检查的临床益处。
回顾性分析2017年8月至2019年11月期间转诊至我院三级医院接受超声引导下乳腺活检的可疑乳腺肿块患者。在此，由经验丰富的专业乳腺放射科医生进行二次评估，进行双侧乳腺超声扫描并回顾先前的影像学检查结果，并将结果与初始评估进行比较。分析活检建议和手术管理（即从乳房肿块切除术改为乳房切除术）方面的解读变化。
本研究共纳入537例患者。109例患者（20%；95%CI，17%-24%）出现解读差异。其中，84例患者（16%；95%CI，13%-19%）的肿块经二次超声检查重新分类为BI-RADS 3类，并接受了2年随访，结果显示82例为良性病变，1例为恶性病变，1例为高危病变。另一方面，16例患者（3%；95%CI，2%-5%）在其他部位进行了活检，发现10例新的恶性病变、3例高危病变和3例良性病变，导致12例患者的手术管理发生改变。此外，9例患者（2%；95%CI，1%-3%）的疾病范围存在差异，这也改变了手术管理。总体而言，21例患者（4%；95%CI，3%-6%）的手术管理因二次超声检查而改变。
活检前二次乳腺超声评估可减少16%患者的不必要活检，并改变4%患者的手术管理，表明它是改善患者护理的一种实用且有价值的方法。
