Efficacy of Second-Look Ultrasound with MR Coregistration for Evaluating Additional Enhancing Lesions of the Breast: Review of the Literature

Abstract

Contrast enhanced magnetic resonance imaging (CE-MRI) has acquired a central role in the field of diagnosis and evaluation of breast cancer due to its high sensitivity; on the other hand, MRI has shown a variable specificity because of the wide overlap between the imaging features of benign and malignant lesions. Therefore, when an additional breast lesion is identified at CE-MRI, a second look with targeted US is generally performed because it provides additional information to further characterise the target lesion and makes it possible to perform US-guided biopsies which are costless and more comfortable for patients compared with MRI-guided ones. Nevertheless, there is not always a correspondence between CE-MR findings and targeted US due to several factors including different operator's experience and position of patients. A new technique has recently been developed in order to overcome these limitations: US with MR coregistration, which can synchronise a sonography image and the MR image with multiplanar reconstruction (MPR) of the same section in real time. The aim of our study is to review the literature concerning the second look performed with this emerging and promising technique, showing both advantages and limitations in comparison with conventional targeted US.

Feasibility, Image Quality and Clinical Evaluation of Contrast-Enhanced Breast MRI Performed in a Supine Position Compared to the Standard Prone Position

“…The patients' informed consent was waived by IRB because this is a retrospective study. In fact, all the supine MRI were performed because the patients had undergone US-guided biopsy with MRI co-registration as described in the literature [9,13]. The supine MRI were performed in the same second week of the cycle as those performed in the prone position; in subjects in menopause they were performed no more than ten days after those in the prone position.…”

“…Recently, the efficacy of MRI volume navigation has been demonstrated [ 9 ]; this method makes it possible to synchronize the MRI performed in a supine position with the ultrasound examination by coupling three pairs of markers: the multiplanar reconstructed MRI image of the corresponding ultrasound image is displayed on the monitor [ 10 , 11 , 12 ]. This new technique permits objectivity during the second-look ultrasound [ 10 ] and reduces the need for MRI-guided biopsy [ 11 , 12 ], but it requires the MRI to be performed in a supine position, that is the same position in which breast ultrasound is performed [ 13 ]. In addition to those already reported, supine MRI offers many other advantages: it has better correspondence with the breast lesions during conservative surgery [ 14 , 15 , 16 , 17 ], it clearly identifies the area of residual presence of the disease [ 18 ], it correctly identifies the volume to be subjected to radiotherapy [ 19 , 20 , 21 ], and effectively maps breast cancer in patients scheduled for oncoplastic surgery [ 15 ].…”

Image-Guided Percutaneous Biopsies

“…In 2009, Nakano et al [37] described the use of a sonographic system that enables real-time sonography with MR navigation. Since then, several vendors have offered systems with different names that permit co-registration and allow synchronization of sonographic and MR images during real-time sonography [38]. These devices can track probe's position and couple real-time ultrasound images to a set of pre-acquired MR images uploaded in the system, displaying magnetic resonance multiplanar reconstruction (MPR) images along with real-time ultrasound images side by side or as overlying (fusion) images.…”

European Journal of Breast Health

“…There are no strict guidelines for the management of SLUS-guided biopsy and follow-up. The reported detection rate of incidental MRI lesion on SLUS ranges from 22% to 100% due to the relatively low specificity of breast MRI (13)(14)(15)(16)(17)(18)(19)(20)(21). Inconsistency between SLUS and MRI findings has been reported in up to 12.5% of followed-up lesions with benign pathology (14).…”

“…In the study by Nakano et al (23), 90% of all lesions were detected using real-time virtual sonography and, in comparison, conventional B-mode imaging had a markedly lower detection rate of only 30%. There are also studies in literature that indicate higher detection rates of real-time virtual sonography (83.8%-100%) (21,23). Notwithstanding, the methods used in these studies require sophisticated technical devices and experience.…”