Original ContributionDiagnostic Performance of Automated Breast Ultrasound as a Replacement for a Hand-Held Second-Look Ultrasound for Breast Lesions Detected Initially on Magnetic Resonance Imaging
Introduction
Magnetic resonance imaging (MRI) of the breast has become an important tool for evaluating patients with known or suspected breast cancer, demonstrating a consistently high sensitivity of 89%–100% (Berg et al., 2004, Gilles et al., 1994, Harms, 1999, Teifke et al., 2002). Unfortunately, the reported specificity of breast MRI is relatively variable, ranging from 26% to 91% (Berg et al., 2004, Gilles et al., 1994, Harms, 1999, Teifke et al., 2002). Therefore, a biopsy is usually required to make a definitive diagnosis when a suspicious lesion is detected on breast MRI (Morris et al., 2002, Orel et al., 1994). MR-directed ultrasound, also known as second-look ultrasound, can provide additional information that can be used to characterize the lesions identified on breast MRI (LaTrenta et al. 2003).
Although breast ultrasound (US) is widely available, relatively inexpensive, free of adverse side effects and well tolerated by patients (Mendelson and Tobin 1995), the high degree of subjectivity and lack of reproducibility of hand-held imaging have discouraged its use (Buchberger et al., 1999, Kopans, 1999); however, it is the first-line modality for the evaluation of MRI-detected lesions. The recently introduced 3-D automated breast ultrasound (ABUS) system provides standardized and uniform images, does not require trained personnel and is less time consuming for physicians. The ABUS system is less dependent on the operator than hand-held US because it allows objective assessment of the entire breast. Interpretation of ABUS data requires a relatively steep learning curve; however, several recent studies have found that 3-D ABUS is feasible (Lander and Tabar, 2011, Shin et al., 2011). We hypothesize that ABUS could replace hand-held second-look US (HH-SLUS) in evaluating patients with additional suspicious lesions on breast MRI. Therefore, the purpose of this study was to evaluate the diagnostic performance of ABUS as a replacement method for HH-SLUS performed after breast MRI. In addition, we assessed inter-observer agreement between three breast radiologists in characterizing lesions using ABUS.
Section snippets
Patient selection
This retrospective study was approved by our institutional review board, and informed consent from the patients was waived. From February through June 2011, a total of 729 breast MRI examinations were performed in our institution. Among these, we included only patients with breast cancer who were newly diagnosed on HHUS and US-guided biopsy except stereotactic biopsy. We excluded patients who were diagnosed with breast cancer on stereotactic biopsy, that is, patients with lesions seen as
Patient characteristics
A total of 80 additional suspicious lesions in 58 patients (age range: 27–63 y, mean: 45 y) were identified by pre-operative breast DCE-MRI. Among these, 13 (16.3%) were pathologically diagnosed as malignant lesions (7 as invasive ductal carcinoma and 6 as ductal carcinoma in situ) (Fig. 2). Fifty lesions (62.5%) were benign according to the histopathologic results of core-needle biopsy or surgery. The remaining 17 lesions were considered benign or probably benign based on imaging (mean: 415 d,
Discussion
For suspicious lesions detected on breast MRI, tissue sampling is required to reach a definitive diagnosis because of the relatively low specificity of breast MRI (Kuhl et al., 2001, Morris et al., 2002, Orel et al., 1994). Because lesions initially identified on breast MRI are usually occult on mammography and clinical examination (Demartini et al. 2009), MRI-guided biopsy or localization is often necessary. Although MRI-guided biopsy is becoming increasingly available, the high cost, length
Conclusions
Automated breast ultrasound can reliably detect additional suspicious lesions that have been identified on breast MRI. In addition, we found moderate agreement between the key features of the lesions and the BI-RADS final assessment. ABUS might be more rapid and less costly than HH-SLUS and may help in the decision on the biopsy guidance method (US vs. MRI) as a replacement tool of HH-SLUS, thereby simplifying patient management. Additional prospective studies, with larger numbers of patients,
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2018, European Journal of RadiologyCitation Excerpt :In the diagnostic setting, high reliability in recording lesion location and size by ABUS was reported in the prospective study of Shin et al. [16]. In preoperative setting, Chae et al. [14] evaluated diagnostic performance of ABUS as a replacement for a hand-held second-look US for MRI detected lesions. ABUS detected 85% (70/80) of suspicious lesions detected on MRI.
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2018, Academic RadiologyCitation Excerpt :In such perspective, Chae et al. (73) reported k = 0.442 in the final BI-RADS assessment, while Girometti et al. (75) showed nearly perfect agreement (k = 0.94). ABUS has also high reliability in identification of lesion location/size and distance from the nipple (intraclass correlation coefficients >0.70) (73). Kim et al. (76) reported lower ability of both ABUS and HHUS to detect a non-mass lesion than a mass-type lesion (P < .05), which confirms the well-known limits of ultrasound examinations, as it is confirmed in a review by Spick et al. (71).
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2017, Academic RadiologyCitation Excerpt :ABVS and MRI both are user independent, which might make them more comparable. Chae et al. evaluated 58 patients with breast cancer who had 80 additional suspicious lesions in MRI, of which 65 (81%) were detected by second-look HHUS and 70 (88%) were detected by ABVS (29), which is very similar to our results (out of 72 lesions in MRI, 54 [75%] were detected by HHUS and 59 [82%] by ABVS). We found good correlation of size measurement between ABVS and MRI (0.89 and accurate estimation in 80.0%), which was slightly better than the correlation of HHUS and MRI (0.82 and accurate estimation in 79.4%).