Skip to main content
Top
Published in:

26-07-2023 | Ultrasound | Original Article–Breast & Thyroid

Contrast-enhanced ultrasound-guided biopsy of suspicious breast lesions on contrast-enhanced mammography and contrast-enhanced MRI: a case series

Authors: Pi-Yi Huang, Meng-Yuan Tsai, Jer-Shyung Huang, Pei-Ying Lin, Chen-Pin Chou

Published in: Journal of Medical Ultrasonics | Issue 4/2023

Login to get access

Abstract

Purpose

To assess the effectiveness of contrast-enhanced ultrasound (CEUS) in guiding biopsies of breast lesions that were detected on contrast-enhanced mammography (CEM) or contrast-enhanced breast MRI (CE-MRI) but were not clearly visible on B-mode ultrasound (B-US).

Methods

In this study, 23 lesions in 16 patients were selected for CEUS-guided biopsy due to poor visualization on B-US despite being detected on CEM (n = 20) or CE-MRI (n = 3). B-US, color Doppler ultrasound (CDUS), and CEUS were used to visualize the suspicious lesions, followed by a CEUS-guided core needle biopsy using Sonazoid as the contrast agent. The accuracy of the biopsy was assessed based on pathology-radiology concordance and 12-month imaging follow-up. The conspicuity scores for lesion visualization were evaluated using a 5-point conspicuity scale agreed upon by two breast radiologists.

Results

The enhancing lesions detected on CEM/CE-MRI had an average size of 1.6 ± 1.3 cm and appeared as mass-enhancing (61%) or non-mass-enhancing (39%). The lesions had mean conspicuity scores of 2.30 on B-US, 2.78 on CDUS, and 4.61 on CEUS, with 96% of the lesions showing contrast enhancement on CEUS. CEUS-guided biopsy showed increased visibility in 96% and 91% of the lesions compared to B-US and CDUS, respectively. The overall accuracy of CEUS-guided biopsy was 100% based on concordance with histology and 12-month follow-up.

Conclusions

CEUS enhances the visibility of suspicious CEM/CE-MRI lesions that are poorly visible on B-US during biopsy procedures.
Literature
1.
go back to reference Chung YE, Kim KW. Contrast-enhanced ultrasonography: advance and current status in abdominal imaging. Ultrasonography. 2015;34:3–18.CrossRefPubMed Chung YE, Kim KW. Contrast-enhanced ultrasonography: advance and current status in abdominal imaging. Ultrasonography. 2015;34:3–18.CrossRefPubMed
2.
go back to reference Miyamoto Y, Ito T, Takada E, et al. Efficacy of sonazoid (perflubutane) for contrast-enhanced ultrasound in the differentiation of focal breast lesions: phase 3 multicenter clinical trial. AJR Am J of roentgenol. 2014;202:W400–7.CrossRef Miyamoto Y, Ito T, Takada E, et al. Efficacy of sonazoid (perflubutane) for contrast-enhanced ultrasound in the differentiation of focal breast lesions: phase 3 multicenter clinical trial. AJR Am J of roentgenol. 2014;202:W400–7.CrossRef
3.
go back to reference Zhou SC, Le J, Zhou J, et al. The role of contrast-enhanced ultrasound in the diagnosis and pathologic response prediction in breast cancer: a meta-analysis and systematic review. Clin Breast Cancer. 2020;20:e490–509.CrossRefPubMed Zhou SC, Le J, Zhou J, et al. The role of contrast-enhanced ultrasound in the diagnosis and pathologic response prediction in breast cancer: a meta-analysis and systematic review. Clin Breast Cancer. 2020;20:e490–509.CrossRefPubMed
4.
go back to reference Zhang F, Jin L, Li G, et al. The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria. Br J Radiol. 2021;94:20200880.CrossRefPubMedPubMedCentral Zhang F, Jin L, Li G, et al. The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria. Br J Radiol. 2021;94:20200880.CrossRefPubMedPubMedCentral
5.
go back to reference Du LW, Liu HL, Gong HY, et al. Adding contrast-enhanced ultrasound markers to conventional axillary ultrasound improves specificity for predicting axillary lymph node metastasis in patients with breast cancer. Br J Radiol. 2021;94:20200874.CrossRefPubMed Du LW, Liu HL, Gong HY, et al. Adding contrast-enhanced ultrasound markers to conventional axillary ultrasound improves specificity for predicting axillary lymph node metastasis in patients with breast cancer. Br J Radiol. 2021;94:20200874.CrossRefPubMed
6.
go back to reference Park HS, Kim YJ, Yu MH, et al. Real-time contrast-enhanced sonographically guided biopsy or radiofrequency ablation of focal liver lesions using perflurobutane microbubbles (sonazoid): value of Kupffer-phase imaging. J Ultrasound Med. 2015;34:411–21.CrossRefPubMed Park HS, Kim YJ, Yu MH, et al. Real-time contrast-enhanced sonographically guided biopsy or radiofrequency ablation of focal liver lesions using perflurobutane microbubbles (sonazoid): value of Kupffer-phase imaging. J Ultrasound Med. 2015;34:411–21.CrossRefPubMed
7.
go back to reference Meissnitzer M, Dershaw DD, Lee CH, et al. Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J of roentgenol. 2009;193:1025–9.CrossRef Meissnitzer M, Dershaw DD, Lee CH, et al. Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J of roentgenol. 2009;193:1025–9.CrossRef
8.
9.
go back to reference Bick U, Trimboli RM, Athanasiou A, et al. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European society of breast imaging. Insights Imag. 2020;11:12.CrossRef Bick U, Trimboli RM, Athanasiou A, et al. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European society of breast imaging. Insights Imag. 2020;11:12.CrossRef
10.
go back to reference Chikarmane SA, Jin B, Giess CS. Accuracy of MRI-directed ultrasound and subsequent ultrasound-guided biopsy for suspicious breast MRI findings. Clin Radiol. 2020;75:185–93.CrossRefPubMed Chikarmane SA, Jin B, Giess CS. Accuracy of MRI-directed ultrasound and subsequent ultrasound-guided biopsy for suspicious breast MRI findings. Clin Radiol. 2020;75:185–93.CrossRefPubMed
11.
go back to reference Moon WK, Im JG, Noh DY, et al. Nonpalpable breast lesions: evaluation with power doppler US and a microbubble contrast agent-initial experience. Radiology. 2000;217:240–6.CrossRefPubMed Moon WK, Im JG, Noh DY, et al. Nonpalpable breast lesions: evaluation with power doppler US and a microbubble contrast agent-initial experience. Radiology. 2000;217:240–6.CrossRefPubMed
12.
13.
go back to reference Raza S, Baum JK. Solid breast lesions: evaluation with power Doppler US. Radiology. 1997;203:164–8.CrossRefPubMed Raza S, Baum JK. Solid breast lesions: evaluation with power Doppler US. Radiology. 1997;203:164–8.CrossRefPubMed
14.
go back to reference Blows FM, Driver KE, Schmidt MK, et al. Subtyping of breast cancer by immunohistochemistry to investigate a relationship between subtype and short and long term survival: a collaborative analysis of data for 10,159 cases from 12 studies. PLoS Med. 2010;7:e1000279.CrossRefPubMedPubMedCentral Blows FM, Driver KE, Schmidt MK, et al. Subtyping of breast cancer by immunohistochemistry to investigate a relationship between subtype and short and long term survival: a collaborative analysis of data for 10,159 cases from 12 studies. PLoS Med. 2010;7:e1000279.CrossRefPubMedPubMedCentral
15.
go back to reference Ghaderi KF, Phillips J, Perry H, et al. Contrast-enhanced Mammography: current applications and future directions. Radiographics. 2019;39:1907–20.CrossRefPubMed Ghaderi KF, Phillips J, Perry H, et al. Contrast-enhanced Mammography: current applications and future directions. Radiographics. 2019;39:1907–20.CrossRefPubMed
16.
go back to reference Landmark KE, Johansen PW, Johnson JA, et al. Pharmacokinetics of perfluorobutane following intravenous bolus injection and continuous infusion of sonazoid in healthy volunteers and in patients with reduced pulmonary diffusing capacity. Ultrasound Med Biol. 2008;34:494–501.CrossRefPubMed Landmark KE, Johansen PW, Johnson JA, et al. Pharmacokinetics of perfluorobutane following intravenous bolus injection and continuous infusion of sonazoid in healthy volunteers and in patients with reduced pulmonary diffusing capacity. Ultrasound Med Biol. 2008;34:494–501.CrossRefPubMed
17.
go back to reference Schrading S, Schild H, Kuhr M, et al. Effects of tamoxifen and aromatase inhibitors on breast tissue enhancement in dynamic contrast-enhanced breast MR imaging: a longitudinal intraindividual cohort study. Radiology. 2014;271:45–55.CrossRefPubMed Schrading S, Schild H, Kuhr M, et al. Effects of tamoxifen and aromatase inhibitors on breast tissue enhancement in dynamic contrast-enhanced breast MR imaging: a longitudinal intraindividual cohort study. Radiology. 2014;271:45–55.CrossRefPubMed
18.
go back to reference Lee JY, Minami Y, Choi BI, et al. The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using sonazoid. Ultrasonography. 2020;39:191–220.CrossRefPubMedPubMedCentral Lee JY, Minami Y, Choi BI, et al. The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using sonazoid. Ultrasonography. 2020;39:191–220.CrossRefPubMedPubMedCentral
Metadata
Title
Contrast-enhanced ultrasound-guided biopsy of suspicious breast lesions on contrast-enhanced mammography and contrast-enhanced MRI: a case series
Authors
Pi-Yi Huang
Meng-Yuan Tsai
Jer-Shyung Huang
Pei-Ying Lin
Chen-Pin Chou
Publication date
26-07-2023
Publisher
Springer Nature Singapore
Published in
Journal of Medical Ultrasonics / Issue 4/2023
Print ISSN: 1346-4523
Electronic ISSN: 1613-2254
DOI
https://doi.org/10.1007/s10396-023-01345-4

Other articles of this Issue 4/2023

Journal of Medical Ultrasonics 4/2023 Go to the issue