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Published in: European Radiology 9/2015

01-09-2015 | Breast

Digital Breast Tomosynthesis (DBT) to Characterize MRI-Detected Additional Lesions Unidentified at Targeted Ultrasound in Newly Diagnosed Breast Cancer Patients

Authors: Giovanna Mariscotti, Nehmat Houssami, Manuela Durando, Pier Paolo Campanino, Elisa Regini, Alberto Fornari, Riccardo Bussone, Isabella Castellano, Anna Sapino, Paolo Fonio, Giovanni Gandini

Published in: European Radiology | Issue 9/2015

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Abstract

Objectives

Preoperative breast magnetic resonance (MR) often generates additional suspicious findings needing further investigations. Targeted breast ultrasound (US) is the standard tool to characterize MR additional lesions. The purpose of this study is to evaluate the potential role of digital breast tomosynthesis (DBT) to characterize MR detected additional findings, unidentified at targeted breast US.

Methods

This prospective study included women who a) had biopsy-proven, newly diagnosed breast cancers detected at conventional 2D mammography and/or US, referred to breast MR for tumour staging; and b) had DBT if additional MR findings were not detected at targeted (‘second look’) US.

Results

In 520 patients, MR identified 164 (in 114 women, 22 %) additional enhancing lesions. Targeted US identified 114/164 (69.5 %) of these, whereas 50/164 (30.5 %) remained unidentified. DBT identified 32/50 of these cases, increasing the overall characterization of MR detected additional findings to 89.0 % (146/164). Using DBT the identified lesions were significantly more likely to be malignant than benign MR-detected additional lesions (p = 0.04).

Conclusions

DBT improves the characterization of additional MR findings not identified at targeted breast US in preoperative breast cancer staging.

Key points

Targeted US identified 114 of 164 (69.5 %) additional enhancing lesions at preoperative breast MRI.
DBT identified a further 32 of the 50 lesions unidentified on targeted US.
DBT improved the characterization of additional MR findings for breast cancer staging.
Literature
1.
go back to reference Bartella L, Liberman L, Morris EA, Dershaw DD (2006) Nonpalpable mammographically occult invasive breast cancers detected by MRI. AJR Am J Roentgenol 186:865–870PubMedCrossRef Bartella L, Liberman L, Morris EA, Dershaw DD (2006) Nonpalpable mammographically occult invasive breast cancers detected by MRI. AJR Am J Roentgenol 186:865–870PubMedCrossRef
2.
go back to reference Orel SG, Schnall MD (2001) MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 220:13–30PubMedCrossRef Orel SG, Schnall MD (2001) MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 220:13–30PubMedCrossRef
3.
go back to reference Houssami N, Ciatto S, Macaskill P et al (2008) Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 26:3248–3258PubMedCrossRef Houssami N, Ciatto S, Macaskill P et al (2008) Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 26:3248–3258PubMedCrossRef
4.
go back to reference Nouri-Neuville M, de Rocquancourt A, Cohen-Zarade S et al (2014) Correlation between MRI and biopsies under second look ultrasound. Diagn Interv Imaging 95:197–211PubMedCrossRef Nouri-Neuville M, de Rocquancourt A, Cohen-Zarade S et al (2014) Correlation between MRI and biopsies under second look ultrasound. Diagn Interv Imaging 95:197–211PubMedCrossRef
5.
go back to reference Carbognin G, Girardi V, Calciolari C et al (2010) Utility of second-look ultrasound in the management of incidental enhancing lesions detected by breast MR imaging. Radiol Med 115:1234–1245PubMedCrossRef Carbognin G, Girardi V, Calciolari C et al (2010) Utility of second-look ultrasound in the management of incidental enhancing lesions detected by breast MR imaging. Radiol Med 115:1234–1245PubMedCrossRef
6.
go back to reference Luciani ML, Pediconi F, Telesca M et al (2011) Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound. Radiol Med 116:886–904PubMedCrossRef Luciani ML, Pediconi F, Telesca M et al (2011) Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound. Radiol Med 116:886–904PubMedCrossRef
7.
go back to reference Fiaschetti V, Salimbeni C, Gaspari E et al (2012) The role of second-look ultrasound of BIRADS-3 mammary lesions detected by breast MR imaging. Eur J Radiol N 81:3178–3184CrossRef Fiaschetti V, Salimbeni C, Gaspari E et al (2012) The role of second-look ultrasound of BIRADS-3 mammary lesions detected by breast MR imaging. Eur J Radiol N 81:3178–3184CrossRef
8.
go back to reference Sardanelli F, Boetes C, Borisch B et al (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46:1296–1316PubMedCrossRef Sardanelli F, Boetes C, Borisch B et al (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46:1296–1316PubMedCrossRef
11.
go back to reference Teifke A, Lehr HA, Vomweg TW, Hlawatsch A, Thelen M (2003) Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. AJR Am J Roentgenol 181:655–662PubMedCrossRef Teifke A, Lehr HA, Vomweg TW, Hlawatsch A, Thelen M (2003) Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. AJR Am J Roentgenol 181:655–662PubMedCrossRef
12.
go back to reference Destounis S, Arieno A, Somerville PA et al (2009) Community-based practice experience of unsuspected breast magnetic resonance imaging abnormalities evaluated with second-look sonography. J Ultrasound Med 28:1337–1346PubMed Destounis S, Arieno A, Somerville PA et al (2009) Community-based practice experience of unsuspected breast magnetic resonance imaging abnormalities evaluated with second-look sonography. J Ultrasound Med 28:1337–1346PubMed
13.
go back to reference Linda A, Zuiani C, Londero V, Bazzocchi M (2008) Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: distribution according to patient history of breast cancer and lesion size. Breast 17:51–57PubMedCrossRef Linda A, Zuiani C, Londero V, Bazzocchi M (2008) Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: distribution according to patient history of breast cancer and lesion size. Breast 17:51–57PubMedCrossRef
14.
go back to reference Meissnitzer M, Dershaw DD, Lee CH, Morris EA (2009) Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol 193:1025–1029PubMedCrossRef Meissnitzer M, Dershaw DD, Lee CH, Morris EA (2009) Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol 193:1025–1029PubMedCrossRef
15.
16.
go back to reference Houssami N, Skaane P (2013) Overview of the evidence on digital breast tomosynthesis in breast cancer detection. Breast 22:101–108PubMedCrossRef Houssami N, Skaane P (2013) Overview of the evidence on digital breast tomosynthesis in breast cancer detection. Breast 22:101–108PubMedCrossRef
17.
go back to reference Skaane P, Gullien R, Bjørndal H et al (2012) Digital breast tomosynthesis (DBT): initial experience in a clinical setting. Acta Radiol 53:524–529PubMedCrossRef Skaane P, Gullien R, Bjørndal H et al (2012) Digital breast tomosynthesis (DBT): initial experience in a clinical setting. Acta Radiol 53:524–529PubMedCrossRef
18.
go back to reference Rafferty EA, Park JM, Philpotts LE et al (2013) Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial. Radiology 266:104–113PubMedCrossRef Rafferty EA, Park JM, Philpotts LE et al (2013) Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial. Radiology 266:104–113PubMedCrossRef
19.
go back to reference Skaane P, Bandos AI, Gullien R et al (2013) Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267:47–56PubMedCrossRef Skaane P, Bandos AI, Gullien R et al (2013) Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267:47–56PubMedCrossRef
20.
go back to reference Ciatto S, Houssami N, Bernardi D et al (2013) Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 14:583–589PubMedCrossRef Ciatto S, Houssami N, Bernardi D et al (2013) Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 14:583–589PubMedCrossRef
22.
go back to reference American College of Radiology (2003) Breast imaging reporting and data system (BIRADS), 4th edn. American College of Radiology, Reston American College of Radiology (2003) Breast imaging reporting and data system (BIRADS), 4th edn. American College of Radiology, Reston
23.
go back to reference Taneja S, Jena A, Zaidi SM, Khurana A (2012) MRI evaluation of the contralateral breast in patients with recently diagnosed breast cancer. Indian J Radiol Imaging 22:69–73PubMedCentralPubMedCrossRef Taneja S, Jena A, Zaidi SM, Khurana A (2012) MRI evaluation of the contralateral breast in patients with recently diagnosed breast cancer. Indian J Radiol Imaging 22:69–73PubMedCentralPubMedCrossRef
24.
go back to reference Mann RM, Loo CE, Wobbes T et al (2010) The impact of preoperative breast MRI on the reexcision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 119:415–422PubMedCrossRef Mann RM, Loo CE, Wobbes T et al (2010) The impact of preoperative breast MRI on the reexcision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 119:415–422PubMedCrossRef
25.
go back to reference Brennan ME, Houssami N, Lord S et al (2009) Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol 27:5640–5649PubMedCrossRef Brennan ME, Houssami N, Lord S et al (2009) Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol 27:5640–5649PubMedCrossRef
26.
go back to reference Kuhl C, Kuhn W, Braun M, Schild H (2007) Pre-operative staging of breast cancer with breast MRI: One step forward, two steps back? Breast 16(Suppl 2):S34–S44PubMedCrossRef Kuhl C, Kuhn W, Braun M, Schild H (2007) Pre-operative staging of breast cancer with breast MRI: One step forward, two steps back? Breast 16(Suppl 2):S34–S44PubMedCrossRef
27.
go back to reference Sardanelli F, Giuseppetti GM, Panizza P et al (2004) Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol 183:1149–1157PubMedCrossRef Sardanelli F, Giuseppetti GM, Panizza P et al (2004) Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol 183:1149–1157PubMedCrossRef
28.
go back to reference Liberman L, Morris EA, Kim CM et al (2003) MR imaging findings in the contralateral breast in women with recently diagnosed breast cancer. AJR Am J Roentgenol 180:333–341PubMedCrossRef Liberman L, Morris EA, Kim CM et al (2003) MR imaging findings in the contralateral breast in women with recently diagnosed breast cancer. AJR Am J Roentgenol 180:333–341PubMedCrossRef
29.
go back to reference Grady I, Gorsuch-Rafferty H, Hadley P (2012) Preoperative staging with magnetic resonance imaging, with confirmatory biopsy, improves surgical outcomes in women with breast cancer without increasing rates of mastectomy. Breast J 18:214–218PubMedCrossRef Grady I, Gorsuch-Rafferty H, Hadley P (2012) Preoperative staging with magnetic resonance imaging, with confirmatory biopsy, improves surgical outcomes in women with breast cancer without increasing rates of mastectomy. Breast J 18:214–218PubMedCrossRef
30.
go back to reference Houssami N, Turner R, Morrow M (2013) Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes. Ann Surg 257:249–255PubMedCrossRef Houssami N, Turner R, Morrow M (2013) Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes. Ann Surg 257:249–255PubMedCrossRef
31.
go back to reference Sung JS, Li J, Da Costa G et al (2014) Preoperative breast MRI for early-stage breast cancer: effect on surgical and long-term outcomes. AJR Am J Roentgenol 202:1376–1382PubMedCrossRef Sung JS, Li J, Da Costa G et al (2014) Preoperative breast MRI for early-stage breast cancer: effect on surgical and long-term outcomes. AJR Am J Roentgenol 202:1376–1382PubMedCrossRef
32.
go back to reference Perlet C, Heywang-Kobrunner SH, Heinig A et al (2006) Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Ancer 106:982–990 Perlet C, Heywang-Kobrunner SH, Heinig A et al (2006) Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Ancer 106:982–990
33.
go back to reference Demartini WB, Eby PR, Peacock S, Lehman CD (2009) Utility of targeted sonography for breast lesions that were suspicious on MRI. AJR Am J Roentgenol 192:1128–1134PubMedCrossRef Demartini WB, Eby PR, Peacock S, Lehman CD (2009) Utility of targeted sonography for breast lesions that were suspicious on MRI. AJR Am J Roentgenol 192:1128–1134PubMedCrossRef
34.
go back to reference Viala J, Gignier P, Perret B et al (2012) Stereotactic vacuum-assisted biopsies on a digital breast 3D-tomosynthesis system. Breast J 19:4–9PubMedCrossRef Viala J, Gignier P, Perret B et al (2012) Stereotactic vacuum-assisted biopsies on a digital breast 3D-tomosynthesis system. Breast J 19:4–9PubMedCrossRef
35.
go back to reference Schrading S, Distelmaier M, Dirrichs T et al (2014) Digital Breast Tomosynthesis-guided Vacuum-assisted Breast Biopsy: Initial Experiences and Comparison with Prone Stereotactic Vacuum-assisted Biopsy. Radiology 11:141397 Schrading S, Distelmaier M, Dirrichs T et al (2014) Digital Breast Tomosynthesis-guided Vacuum-assisted Breast Biopsy: Initial Experiences and Comparison with Prone Stereotactic Vacuum-assisted Biopsy. Radiology 11:141397
36.
go back to reference Mariscotti G, Houssami N, Durando M et al (2014) Accuracy of mammography, digital breast tomosynthesis, ultrasound and MR imaging in preoperative assessment of breast cancer. Anticancer Res 34:1219–1225PubMed Mariscotti G, Houssami N, Durando M et al (2014) Accuracy of mammography, digital breast tomosynthesis, ultrasound and MR imaging in preoperative assessment of breast cancer. Anticancer Res 34:1219–1225PubMed
Metadata
Title
Digital Breast Tomosynthesis (DBT) to Characterize MRI-Detected Additional Lesions Unidentified at Targeted Ultrasound in Newly Diagnosed Breast Cancer Patients
Authors
Giovanna Mariscotti
Nehmat Houssami
Manuela Durando
Pier Paolo Campanino
Elisa Regini
Alberto Fornari
Riccardo Bussone
Isabella Castellano
Anna Sapino
Paolo Fonio
Giovanni Gandini
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3669-4

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