Sonographic Findings of Additional Malignant Lesions in Breast Carcinoma Seen by Second Look Ultrasound

Abstract

Objective:The aim is to show ultrasound (US) findings of additional malignant lesions of breast carcinoma visualized on targeted second-look US that were not identified by mammography or US prior to the time of diagnosis.Materials and Methods:A double-blind retrospective review of the US results from January 2008 through August 2010 of 228 patients with known breast cancer was conducted by two expert radiologists. The focus of the review was on the second-look US characteristics (following BI-RADS criteria) of 26 documented additional malignant lesions of the 76 with successful sonographic correlation from the 123 lesions detected by magnetic resonance imaging (MRI). All of them, before the MRI, had an initial mammography and a US with a histopathological biopsy of the primary lesion.Results:Approximately 60 to 70% of the findings were classified as BI-RADS 2 and BI-RADS 3, while assessing the final US category. The review of the second-look US showed the size of the second malignant additional lesion ranged from 3 to 22 mm, of which 90% were smaller than 10 mm and 66% were smaller than 7 mm.Conclusions:Most additional malignant lesions, nonpalpable carcinomas, which were previously not detected by mammography and US at first-look diagnosis, were detected by a targeted second-look US examination. These lesions were of category BI-RADS 2 and BI-RADS 3 and smaller than 7 mm.

Diagnostic Utility of Second-Look US for Breast Lesions Identified at MR Imaging: Systematic Review and Meta-Analysis

“…Evaluation of the risk of bias and applicability of the included studies regarding the study purpose by using the QUADAS-2 tool demonstrated an unclear risk of bias owing to incomplete, nonconsecutive, or not-reported details on patient selection in six studies (14,15,23,24,26,27). Uncertainty regarding a reference-standard description, as well as the flow and timing of the study, were present in one study (26), whereas no risk of bias was found regarding the index test.…”

“…Two studies (11.8%) included only patients with unclear MR imaging findings (27,28). The number of observers reading MR images and second-look US scans was not provided in four studies (15,17,23,26). Observer experience with US was given in only six studies (17,19,21,22,25,29), and observer experience with MR imaging was stated in another six studies (14,19,21,25,29,30).…”

“…Patient recruitment was consecutive in 14 (82.4%) studies. One study described nonconsecutive patient recruitment (24), and, in another two studies, patient recruitment was not clearly described (26,27). Data on patient ages were provided by all but two studies (26,27), with mean ages ranging between 40 and 52 years within a minimum of 21 years of age and a maximum of 90 years of age (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(26)(27)(28).…”

“…Data on patient ages were provided by all but two studies (26,27), with mean ages ranging between 40 and 52 years within a minimum of 21 years of age and a maximum of 90 years of age (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(26)(27)(28). Inclusion criteria were suspicious MR imaging lesions in seven (41.2%) studies (14,(19)(20)(21)(22)24,26,29) and suspicious or unclear MR imaging findings in eight (47.1%) studies (14)(15)(16)(17)23,25,30). Two studies (11.8%) included only patients with unclear MR imaging findings (27,28).…”

Supine breast US: how to correlate breast lesions from prone MRI

“…15,[19][20][21][22][23][24][25][26] Ultrasound lesion detection is influenced by lesion echo texture compared with breast background tissue and by lesion MRI appearance. A higher correlation of second-look ultrasound for mass lesions rather than non-mass ones has been reported.…”