Can second-look ultrasound downgrade MRI-detected lesions? A retrospective study. Issue 127 (June 2020)

• Record Type: Journal Article
• Authors: Kolta, Michael; Clauser, Paola; Kapetas, Panagiotis; Bernathova, Maria; Pinker, Katja; Helbich, Thomas H.; Baltzer, Pascal A.T.
• Is Part Of: European journal of radiology. Issue 127(2020)
• Publication Date: 2020-06
• Subjects: Second-look ultrasound -- Breast cancer -- Magnetic resonance imaging -- Image- guided biopsy -- BI-RADS; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.108976
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: A benign appearance on second-look ultrasound can downgrade MRI BI-RADS 4 lesions. Second-look ultrasound BI-RADS 2 lesions did not yield false-negative results. This study demonstrates the potential to avoid 30 % of all unnecessary biopsies. 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.