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Real-time MRI navigated US: role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US.
Eur J Radiol. 2014 Jun; 83(6):942-950.EJ

Abstract

OBJECTIVES

To prospectively evaluate the accuracy of real-time ultrasound combined with supine-MRI using volume navigation technique (RtMR-US) in diagnosis and biopsy of incidental breast lesions (ILSM) and axillary lymph nodes (LNSM) suspicious of malignancy on contrast enhanced magnetic resonance imaging (CE-MRI).

MATERIALS AND METHODS

Five hundred and seventy-seven women were examined using breast CE-MRI. Those with incidental breast lesions not identified after second-look ultrasound (US) were recruited for RtMR-US. Biopsy was performed in ILSM. Breast lesions were categorized with BI-RADS system and Fisher' exact test. Axillary lymph nodes morphology was described. To assess efficacy of RtMR-US, diagnostic accuracy, sensitivity, specificity, detection rate and Kappa index of conventional-US and RtMR-US were calculated.

RESULTS

Forty-three lesions were detected on CE-MRI before navigation. Eighteen were carcinomas and 25 ILSM. Of these, 21 underwent a RtMR-US. Detection rate on RtMR-US (90.7%) was higher than on conventional-US (43%) (p<0.001). Agreement between both techniques was low (k=0.138). Twenty ILSM and 2 LNSM were biopsied. Sixty-five percent were benign (100% of BI-RADS3 and 56% of BI-RADS4-5). Diagnostic performance of RtMR-US identifying malignant nodules for overall lesions and for the subgroup of ILSM was respectively: sensitivity 96.3% and 100%, specificity 18.8% and 30.7%, positive predictive value 66.7% and 43.7%, negative predictive value 75% and 100%. In addition RtMR-US enabled biopsy of 2 metastatic lymph nodes.

CONCLUSIONS

Real time-US with supine-MRI using a volume navigation technique increases the detection of ILSM. RtMR-US may be used to detect occult breast carcinomas and to assess cancer extension, preventing unnecessary MRI-guided biopsies and sentinel lymph node biopsies. Incidental lesions BI-RADS 3 non-detected on conventional-US are probably benign.

Authors+Show Affiliations

University Hospital Virgen de las Nieves, Servicio de Radiodiagnóstico Hospital Materno Infantil, Avenida de las Fuerzas Armadas s/n, 18004 Granada, Spain. Electronic address: elenapastorpons@gmail.com.University Hospital Virgen de las Nieves, Servicio de Radiodiagnóstico Hospital Materno Infantil, Avenida de las Fuerzas Armadas s/n, 18004 Granada, Spain. Electronic address: frmiaz00@gmail.com.University Hospital Virgen de las Nieves, Servicio de Radiodiagnóstico Hospital Materno Infantil, Avenida de las Fuerzas Armadas s/n, 18004 Granada, Spain. Electronic address: mariacc1980@gmail.com.University Hospital Virgen de las Nieves, Servicio de Radiodiagnóstico Hospital Materno Infantil, Avenida de las Fuerzas Armadas s/n, 18004 Granada, Spain. Electronic address: isalvaa@hotmail.com.University Hospital Virgen de las Nieves, Servicio de Radiodiagnóstico Hospital Materno Infantil, Avenida de las Fuerzas Armadas s/n, 18004 Granada, Spain. Electronic address: gespona@hotmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24725672

Citation

Pons, Elena Pastor, et al. "Real-time MRI Navigated US: Role in Diagnosis and Guided Biopsy of Incidental Breast Lesions and Axillary Lymph Nodes Detected On Breast MRI but Not On Second Look US." European Journal of Radiology, vol. 83, no. 6, 2014, pp. 942-950.
Pons EP, Azcón FM, Casas MC, et al. Real-time MRI navigated US: role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US. Eur J Radiol. 2014;83(6):942-950.
Pons, E. P., Azcón, F. M., Casas, M. C., Meca, S. M., & Espona, J. L. G. (2014). Real-time MRI navigated US: role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US. European Journal of Radiology, 83(6), 942-950. https://doi.org/10.1016/j.ejrad.2014.03.006
Pons EP, et al. Real-time MRI Navigated US: Role in Diagnosis and Guided Biopsy of Incidental Breast Lesions and Axillary Lymph Nodes Detected On Breast MRI but Not On Second Look US. Eur J Radiol. 2014;83(6):942-950. PubMed PMID: 24725672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real-time MRI navigated US: role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US. AU - Pons,Elena Pastor, AU - Azcón,Francisco Miras, AU - Casas,María Culiañez, AU - Meca,Salvador Martínez, AU - Espona,José Luis García, Y1 - 2014/03/22/ PY - 2013/08/06/received PY - 2014/02/24/revised PY - 2014/03/01/accepted PY - 2014/4/15/entrez PY - 2014/4/15/pubmed PY - 2014/12/19/medline KW - Breast cancer KW - Magnetic resonance imaging fusion KW - Magnetic resonance navigated ultrasound KW - Real-time ultrasound KW - Second look ultrasound SP - 942 EP - 950 JF - European journal of radiology JO - Eur J Radiol VL - 83 IS - 6 N2 - OBJECTIVES: To prospectively evaluate the accuracy of real-time ultrasound combined with supine-MRI using volume navigation technique (RtMR-US) in diagnosis and biopsy of incidental breast lesions (ILSM) and axillary lymph nodes (LNSM) suspicious of malignancy on contrast enhanced magnetic resonance imaging (CE-MRI). MATERIALS AND METHODS: Five hundred and seventy-seven women were examined using breast CE-MRI. Those with incidental breast lesions not identified after second-look ultrasound (US) were recruited for RtMR-US. Biopsy was performed in ILSM. Breast lesions were categorized with BI-RADS system and Fisher' exact test. Axillary lymph nodes morphology was described. To assess efficacy of RtMR-US, diagnostic accuracy, sensitivity, specificity, detection rate and Kappa index of conventional-US and RtMR-US were calculated. RESULTS: Forty-three lesions were detected on CE-MRI before navigation. Eighteen were carcinomas and 25 ILSM. Of these, 21 underwent a RtMR-US. Detection rate on RtMR-US (90.7%) was higher than on conventional-US (43%) (p<0.001). Agreement between both techniques was low (k=0.138). Twenty ILSM and 2 LNSM were biopsied. Sixty-five percent were benign (100% of BI-RADS3 and 56% of BI-RADS4-5). Diagnostic performance of RtMR-US identifying malignant nodules for overall lesions and for the subgroup of ILSM was respectively: sensitivity 96.3% and 100%, specificity 18.8% and 30.7%, positive predictive value 66.7% and 43.7%, negative predictive value 75% and 100%. In addition RtMR-US enabled biopsy of 2 metastatic lymph nodes. CONCLUSIONS: Real time-US with supine-MRI using a volume navigation technique increases the detection of ILSM. RtMR-US may be used to detect occult breast carcinomas and to assess cancer extension, preventing unnecessary MRI-guided biopsies and sentinel lymph node biopsies. Incidental lesions BI-RADS 3 non-detected on conventional-US are probably benign. SN - 1872-7727 UR - https://www.unboundmedicine.com/medline/citation/24725672/Real_time_MRI_navigated_US:_role_in_diagnosis_and_guided_biopsy_of_incidental_breast_lesions_and_axillary_lymph_nodes_detected_on_breast_MRI_but_not_on_second_look_US_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0720-048X(14)00142-9 DB - PRIME DP - Unbound Medicine ER -