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Vol. 60. Issue 5.
Pages 413-423 (September - October 2018)
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Vol. 60. Issue 5.
Pages 413-423 (September - October 2018)
Original Report
DOI: 10.1016/j.rxeng.2018.07.005
Usefulness of the twinkling artifact on Doppler ultrasound for the detection of breast microcalcifications
Utilidad del artefacto Doppler de centelleo de color (twinkle) en la detección ecográfica de microcalcificaciones mamarias
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A. Relea
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arelea@yahoo.es

Corresponding author.
, J.A. Alonso, M. González, C. Zornoza, S. Bahamonde, B.E. Viñuela, M.B. Encinas
Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, Spain
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Table 1. Numerical classification based on the morphology and distribution of microcalcifications.
Table 2. Comparative chart of the diagnostic performance of ultrasound-guided biopsy of suspicious microcalcifications.
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Abstract
Objective

To determine whether the twinkling artifact on Doppler ultrasound imaging corresponds to microcalcifications previously seen on mammograms and to evaluate the usefulness of this finding in the ultrasound management of suspicious microcalcifications.

Material and methods

We used ultrasonography to prospectively examine 46 consecutive patients with groups of microcalcifications suspicious for malignancy identified at mammography, searching for the presence of the twinkling artifact to identify the microcalcifications. Once we identified the microcalcifications, we obtained core-needle biopsy specimens with 11G needles and then used X-rays to check the specimens for the presence of microcalcifications. We analyzed the percentage of detection and obtainment of microcalcifications by core-needle biopsy with this technique and the radiopathologic correlation. Microcalcifications that were not detected by ultrasound or discordant lesions were biopsied by stereotaxy at another center. We also used ultrasound guidance for preoperative marking with clips, usually orienting them radially.

Results

We identified and biopsied 41 of the 46 lesions under ultrasound guidance, including 24 of 25 carcinomas (17 in situ). B-mode ultrasound was sufficient for biopsying the microcalcifications in 14 patients, although the presence of the twinkling artifact increased the number of microcalcifications detected and thus enabled more accurate preoperative marking. Thanks to the twinkling sign, we were able to identify 27 additional groups of microcalcifications (89% vs. 30%; p<0.05). All the surgical specimens had margins free of disease.

Conclusions

The twinkling artifact is useful for microcalcifications in ultrasound examinations, enabling a significant increase in the yield of ultrasound-guided biopsies and better preoperative marking of groups of microcalcifications.

Keywords:
Mammograms
Breast tumor
Core biopsy
Breast ultrasound
Doppler ultrasonography
Artifacts
Microcalcifications
Resumen
Objetivo

Verificar si el artefacto de twinkle (AT) se corresponde con la presencia de microcalcificaciones previamente vistas mediante mamografía, y valorar su utilidad en el manejo ecográfico de microcalcificaciones sospechosas.

Material y métodos

Hemos examinado prospectivamente mediante ecografía a 46 pacientes consecutivas con grupos de microcalcificaciones sospechosos de malignidad, sin otros hallazgos mamográficos de sospecha, buscando la presencia del AT para identificar las microcalcificaciones. Cuando lo conseguimos, procedimos a biopsiarlas con aguja gruesa (BAG) 11G, y posteriormente comprobamos la presencia de las microcalcificaciones mediante radiografía de las muestras obtenidas. Analizamos el porcentaje de detección y obtención de microcalcificaciones con la BAG, usando esta técnica, así como la concordancia radiopatológica. Las microcalcificaciones no detectadas con ecografía, o no concordantes, fueron biopsiadas mediante estereotaxia en otro centro. También utilizamos guía ecográfica para el marcaje preoperatorio con arpones, orientándolos habitualmente de forma radial.

Resultados

Se identificaron y biopsiaron con ecografía 41 de las 46 lesiones, incluyendo 24 de los 25 carcinomas (17 de ellos in situ). La ecografía en modo B bastó para biopsiar las microcalcificaciones en 14 pacientes, aunque en 6 de ellas el AT incrementó el número de microcalcificaciones detectadas, lo que permitió un marcaje preoperatorio más preciso. Gracias al AT identificamos 27 grupos adicionales (89% vs. 30%; p<0,05). Todas las piezas quirúrgicas mostraron bordes libres.

Conclusiones

El AT es una herramienta útil para la identificación ecográfica de microcalcificaciones, lo que permite un significativo incremento de las biopsias guiadas por ecografía, así como una mejor delimitación preoperatoria.

Palabras clave:
Mamografía
Neoplasia mamaria
Biopsia con aguja gruesa
Ecografía mamaria
Ecografía Doppler
Artefactos
Microcalcificaciones

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