Dynamic optical breast imaging: a novel technique to detect and characterize tumor vessels

Purpose

To prospectively determine the diagnostic accuracy of optical absorption imaging in patients with Breast Imaging Reporting and Data System (BI-RADS) 3–5 breast lesions.

Materials and methods

Forty-six patients with BI-RADS classification 3 (11%), 4 (44%) or 5 (44%) lesions, underwent a novel optical imaging examination using red light to illuminate the breast. Pressure was applied on the breast, and time-dependent curves of light absorption were recorded. Curves that consistently increased or decreased over time were classified as suspicious for malignancy. All patients underwent a core or surgical biopsy.

Results

Optical mammography showed a statistical difference in numbers of suspect pixels between benign (N = 12) and malignant (N = 35) lesions (respectively 1325 vs. 3170, P = 0.002). In this population, optical imaging had a sensitivity of 74%, specificity of 92%, and diagnostic accuracy of 79%. The optical signal did not vary according to any other parameter including breast size or density, age, hormonal status or histological type of lesions.

Conclusion

Optical imaging is a low-cost, non-invasive technique, yielding physiological information dependent on breast blood volume and oxygenation. It appears to have a good potential for discriminating benign from malignant lesions. Further studies are warranted to define its potential role in breast cancer imaging.     

Effect of adding screening ultrasonography to screening mammography on patient recall and cancer detection rates: A retrospective study in Japan

Purpose

To determine whether adding screening ultrasonography to screening mammography can reduce patient recall rates and increase cancer detection rates.

Materials and methods

We analyzed the results of mammography and ultrasonography breast screenings performed at the Total Health Evaluation Center Tsukuba, Japan, between April 2011 and March 2012. We also reviewed the modalities and results of diagnostic examinations from women with mammographic abnormalities who visited the Tsukuba Medical Center Hospital for further testing.

Results

Of 11,753 women screened, cancer was diagnosed in 10 (0.22%) of the 4529 participants who underwent mammography alone, 23 (0.37%) of the 6250 participants who underwent ultrasonography alone, and 5 (0.51%) of the 974 participants who underwent mammography and ultrasonography. The recall rate due to mammographic abnormalities was 4.9% for women screened only with mammography and 2.6% for those screened with both modalities. The cancer detection rate was 0.22% for women screened only with mammography (positive predictive value, 4.5%) and 0.31% for those screened with both modalities (positive predictive value, 12.0%).Of the 211 lesions presenting as mammographic abnormalities investigated further, diagnostic ultrasonography found no abnormalities in 63 (29.9%) and benign findings in 69 (33.7%). The rest 36.4% needed mammography, cytological or histological examinations or follow-up in addition to diagnostic ultrasonography.

Conclusions

It is possible to reduce the recall rate in screening mammography by combining mammography and ultrasonography for breast screening.     

Characterization and guided-procedures of breast suspicious microcalcifications: can MicroPure ultrasound do it?

Objective

To assess the diagnostic value of high-frequency (MicroPure) ultrasound in evaluating suspicious microcalcifications and to determine its capability in biopsy guidance.

Subjects and methods

Sixty-two cases with suspicious microcalcifications detected on mammographic examination had been re-evaluated by MicroPure US. The studied cases underwent true cut tissue/surgical excision biopsy. Histopathology revealed 25 benign and 37 malignant lesions and was considered the gold standard of reference.

Results

Malignant microcalcifications were easier to be visible at MicroPure US, as they were detected in 86.5% (n = 32/39) compared to only 68% (n = 17/25) of the benign lesions. US depicted more breast masses associated with malignant microcalcifications in 78% (n = 29/37) than those associated with benign ones seen in 36% (n = 9/25).Visibility of suspicious microcalcifications at US was aided by preliminary mammogram. Given known mammography location of these microcalcifications had made their visualization accessible by MicroPure US in 79% (n = 49) of the cases.

Conclusion

MicroPure ultrasound cannot discriminate benign from malignant breast microcalcifications. MicroPure can be useful in detecting clustered microcalcifications that are not accessible by B-mode ultrasound; provided knowledge of their mammographic location and thus can provide better guidance for pre-surgical wire localization and ultrasound-guided biopsies.     

Value of mammography and combined grey scale ultrasound and ultrasound elastography in the differentiation of solid breast lesions

Aim of the work

The aim of this work was to evaluate the value of ultrasound elastography (UE) in differentiating benign versus malignant solid breast lesions discovered in mammography and compare it with grey scale ultrasound (US) and mammography.

Methods

From May 2011 to May 2013, 114 solid lesions from 100 consecutive patients discovered during mammography were categorized into benign or malignant by mammography and US and further analyzed with UE. The diagnostic results of the cases were compared with histopathologic findings.

Results

Of 114 lesions, 33 were histologically malignant, and 81 were benign. UE was the most specific (95.1%) of the 3 modalities. The accuracy (81.7%) of UE was equal to mammography and was higher than those of US (82.5% and 71.9%, respectively). A combination of UE and US had the best sensitivity (90.9%) and accuracy (93.8%).

Conclusions

Ultrasound elastography is useful for breast lesion characterization and is an easier and cheaper method and more specific than mammography or US alone, but it is operator dependent. When combined with US, detection accuracy can be greatly improved and the combination potentially could reduce unnecessary biopsy.     

Assessment of breast lesions using BI-RADS US lexicon in mammographically dense breasts (ACR categories 3 and 4) with histopathological correlation

Purpose

To assess the role of ultrasonography in detection, and categorization of breast lesions in patients with mammographically dense breasts with the use of the BI-RADS US lexicon.

Patients and methods

This study included 60 female patients (age range from 20 to 80 years, mean 38.3 ± 11.9) complaining of mastalgia, breast lump or nipple discharge with mammographically dense breast tissue. Breast ultrasound was performed to all patients with a 12-MHz linear-array transducer. Sonographic findings of the breast lesions were described and categorized according to the BI-RADS US assessment categories. Biopsy procedures were performed for the sonographically detected breast lesions with histopathological examination of the biopsied tissue.

Results

The main complaint was palpable breast mass encountered in 25 patients, 12 of mastalgia, 4 of nipple discharge, 12 patients were on screening and 7 on follow up. 36 patients were categorized as ACR 3 and 24 ACR 4 regarding the density of their breasts in mammography. Mammography revealed no abnormalities in 31 patients and abnormal in 29 patients, the commonest mammographic finding was breast mass, detected in 19 patients. Ultrasound detected breast lesions in 56 (93.3%) out of 60 patients. BI-RADS US category 2 was the most common category representing 36.7%. Ultrasonography had a diagnostic reliability for differentiating between benign and malignant breast lesions (p = 0.869) in mammographically dense breasts while mammography was diagnostically unreliable (p = 0.045).

Conclusion

Ultrasound is a mandatory adjunct to mammography in detection and characterization of breast lesions in mammographically dense breasts.     

Interobserver reliability of automated breast volume scanner (ABVS) interpretation and agreement of ABVS findings with hand held breast ultrasound (HHUS), mammography and pathology results

Objectives

Handheld breast ultrasound (HHUS) lacks standardization and reproducibility. The automated breast volume scanner (ABVS) could overcome this limitation. To analyze the interobserver reliability of ABVS and the agreement with HHUS, mammography and pathology is the aim of this study.

Methods

All 42 study participants (=84 breasts) received an ABVS examination in addition to the conventional breast diagnostic work-up. 25 breasts (30%) showed at least one lesion. The scans were interpreted by six breast diagnostic specialists blinded to results of breast imaging and medical history. 32 lesions received histological work-up: 20 cancers were detected. We used kappa statistics to interpret agreement between examiners and diagnostic instruments.

Results

On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification of the 84 breasts an agreement (defined as ≥4 of 6 examiners) was achieved in 63 cases (75%) (mk = 0.35) and even improved when dichotomizing the interpretation in benign (BI-RADS 1, 2) and suspicious (BI-RADS 4, 5) to 98% (mk = 0.52). Agreement of ABVS examination to HHUS, mammography and pathology was fair to substantial depending on the specific analysis.

Conclusions

The development of an ABVS seems to be a promising diagnostic method with a good interobserver reliability, as well as a comparable good test criteria as HHUS.     

Magnetic resonance imaging of radial sclerosing lesions (radial scars) of the breast

Purpose

To identify magnetic resonance (MR) imaging (MRI) features of radial sclerosing lesions (RSLs) of the breast.

Methods and materials

The radiologic and pathologic records for 4629 consecutive patients undergoing MR examinations of the breast were retrospectively reviewed. Patients who received a pathologic diagnosis of RSL without atypia or carcinoma at surgical excision were identified. The MR images were evaluated according to the BI-RADS-MRI lexicon by two experienced breast radiologists. The frequency of morphologic and kinetic patterns and of BI-RADS-MRI assessment categories was calculated.

Results

Twenty-nine patients with 29 surgically excised RSL were identified.Nine (31%) RSL were MR-occult; the remaining 20 (69%) RSL presented as masses (10/20, 50%), architectural distortions (5/20, 25%), non-mass lesions (4/20, 20%), and focus (1/20, 5%). Kinetic analysis was performed in 18 RSL: enhancement features were benign in 9 (50%) cases, suspicious in 7 (39%) cases and indeterminate in 2 (11%) cases. Twelve (41%) MR examinations were assessed as suspicious (BI-RADS-MRI 4 and 5), and 17 (59%) as negative (BI-RADS-MRI 1) or benign (BI-RADS-MRI 2 and 3).

Conclusion

RSLs are often visualized on MR imaging. Just as in mammography and sonography, RSL can have variable morphologic and kinetic features, and not infrequently they can mimic invasive carcinoma of the breast.     

Can 18F-FDG PET improve the evaluation of suspicious breast lesions on MRI?

Objective

To evaluate the impact of adding 18F-fluorine-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in the evaluation of suspicious breast lesions on magnetic resonance imaging (MRI).

Methods

Sixty patients with suspicious breast lesions on MRI were selected to perform a PET–CT in prone position, dedicated to the evaluation of the breasts. The areas with increased 18F-FDG concentration relative to normal parenchyma were considered positive on PET–CT. Fusion of PET and MRI images (PET–MRI) was performed on a dedicated workstation to better locate corresponding lesions, and its findings were compared with histological results.

Results

76 lesions were evaluated, including 64 mass lesions (84.2%) and 12 non-mass lesions (15.8%). Lesions’ mean diameter on MRI was 29.6 ± 19.2 mm (range 6–94 mm). PET–CT showed increased metabolically activity on 57 lesions (75.0%), with mean maximum SUV of 5.7 ± 5.0 (range 0.8–23.1). On histopathology, there were 17 (22.4%) benign and 59 (79.7%) malignant lesions. Considering all lesions, PET–MRI fusion provided 89.8% sensitivity, 76.5% specificity and 86.8% accuracy. Considering only mass lesions higher than 10 mm, PET–MRI fusion provided 95.8% sensitivity, 83.3% specificity and 93.3% accuracy.

Conclusion

The inclusion of 18F-FDG PET on the evaluation of suspicious breast lesions on MRI helped to differentiate benign from malignant breast lesions, especially for mass lesions with a diameter higher than 10 mm.     

Real-time tissue elastography combined with BIRADS-US classification system for improving breast lesion evaluation

Purpose

The purpose of this study was to establish the correlation of prospectively interpreted ultrasound elastography (USE) results with American College of Radiology Breast Imaging Reporting and Data System (BIRADS) assessment and pathologic diagnoses of sonographically visible breast masses and to determine whether USE can improve distinction of benign and malignant lesions.

Patients and methods

Between April 2012 and January 2014, sonoelastography of focal breast lesions was carried out in 410 patients with subsequent histological confirmation. We present data focusing on the sensitivity (SE), specificity (SP) and the positive (PPV) and negative predictive value (NPV) of sonoelastography. In addition we performed an analysis of the diagnostic performance, expressed by the pretest and posttest probability of disease (POD), in BI-RADS-US 3 or 4 lesions as these categories can imply both malignant and benign lesions and a more precise prediction would be a preferable aim.

Results

Sonoelastography demonstrated an improved SP (89.5%) and an excellent PPV (86.8%) compared to B-mode ultrasound (76.1% and 77.2%). Especially in dense breasts ACR III–IV, the SP was even higher (92.8%). In BI-RADS-US 3 lesions, a suspicious elastogram significantly modified the POD from 8.3% to a posttest POD of 45.5%. In BI-RADS-US 4 lesions, we found a pretest POD of 56.6%. The posttest POD changed significantly to 24.2% with a normal elastogram and to 81.5% with a suspicious elastogram.

Conclusions

Real-time tissue elastography may provide additional characterization of breast lesions, improving specificity, particularly for BIRADS 3 and BIRADS 4 lesions.     

Accuracy of CESM versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation

Aim

Assess accuracy of contrast enhanced spectral mammography (CESM) versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation.

Differentiation of benign and malignant breast lesions: A comparison between automatically generated breast volume scans and handheld ultrasound examinations

Objective

To assess the diagnostic value of automated breast volume scanning (ABVS) or conventional handheld ultrasonography (HHUS) for the differentiation of benign and malignant breast lesions.

Materials and methods

The study prospectively evaluated 239 lesions in 213 women who were scheduled for open biopsy. The patients underwent ABVS and conventional HHUS. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive and negative predictive values for HHUS and ABVS images were calculated using histopathological examination as the gold standard. Additionally, diagnostic accuracy was further evaluated according to the size of the masses.

Results

Among the 239 breast lesions studied, pathology revealed 85 (35.6%) malignant lesions and 154 (64.4%) benign lesions. ABVS was similar to HHUS in terms of sensitivity (95.3% vs. 90.6%), specificity (80.5% vs. 82.5%), accuracy (85.8% vs. 85.3%), positive predictive value (73.0% vs. 74.0%), and negative predictive value (93.3% vs. 94.1%). The area under the receiver operating characteristic (ROC) curve, which is used to estimate the accuracy of the methods, demonstrated only minor differences between HHUS and ABVS (0.928 and 0.948, respectively).

Conclusions

The diagnostic accuracy of HHUS and ABVS in differentiating benign from malignant breast lesions is almost identical. However, ABVS can offer new diagnostic information. ABVS may help to distinguish between real lesions and inhomogeneous areas, find small lesions, and demonstrate the presence of intraductal lesions. This technique is feasible for clinical applications and is a promising new technique in breast imaging.     

Value of the correct diagnostic pathway through conventional imaging (mammography and ultrasound) in evaluating breast disease

Purpose

This study evaluated the role of the correct diagnostic pathway through conventional imaging in evaluating breast disease.

Materials and methods

Six hundred patients aged between 35 and 75 years were enrolled in the study. All patients underwent detailed history and clinical examination, ultrasound (US) and mammography. US scans were repeated after mammography. All suspicious lesions were studied by cytological and histological characterisation and magnetic resonance (MR) imaging.

Results

The first US scan showed 147 solid lesions, 67 lesions characterised by posterior acoustic shadowing and 193 areas of heterogeneous echostructure. The second US scan, performed after mammography, confirmed 123/147 solid nodular lesions, 53/67 lesions characterised by posterior acoustic shadowing and 183/193 areas of heterogeneous echostructure; it also showed 13 nodular lesions not seen on the first scan and two cases of nodular lesions with irregular calcifications.

Conclusions

Our experience suggests that US not performed in conjunction with mammography gives rise to incorrect diagnostic interpretations (either false positive or false negative results). The detection rate of the US scan performed after mammography increases from 4.16% to5.5%.

     

Dynamic MR-Mammography as the best method for diagnosis of invasive lobular breast carcinoma: A retrospective study

Aim of the study

It is a retrospective study aiming to provide diagnostic characterization of ILC in Dynamic MR-Mammography and to compare its diagnostic performance to mammography and ultrasonography.

Material and Method

A total of 56 cases of ILC were selected in retrospective review of mammography, ultrasonography and Dynamic MRM of 420 patients with invasive breast cancer.

Results

Asymmetric density was the commonest mammography finding and the measured sensitivity of mammography in detecting ILC was 87.5% (9/56 FN).The most common US manifestation of ILC was focal shadowing without a discrete mass and its sensitivity in detecting ILC was 84.9% (10/56 FN). At MR imaging, the most common manifestation of ILC was a solitary irregular or angular mass with speculated or ill-defined margins (33.9%of cases [n = 19]).The measured sensitivity is 96.5% (2/56 FN). Additional data such as those affected the patient management including the presence of multifocal or multicentric disease, chest wall involvement and contralateral breast cancer were encountered in 48.2% of cases [n = 27]. ILC has a tendency to demonstrate delayed maximum enhancement with washout exhibited by only a minority of lesions (21.4% [n = 12]).

Conclusion

MR imaging has proved to be superior to mammography and US in the detection and management of ILC. It provides useful information for further management and pre-surgical planning.     

A computerized global MR image feature analysis scheme to assist diagnosis of breast cancer: a preliminary assessment

Objectives

To develop a new computer-aided detection scheme to compute a global kinetic image feature from the dynamic contrast enhanced breast magnetic resonance imaging (DCE-MRI) and test the feasibility of using the computerized results for assisting classification between the DCE-MRI examinations associated with malignant and benign tumors.

Materials and Methods

The scheme registers sequential images acquired from each DCE-MRI examination, segments breast areas on all images, searches for a fraction of voxels that have higher contrast enhancement values and computes an average contrast enhancement value of selected voxels. Combination of the maximum contrast enhancement values computed from two post-contrast series in one of two breasts is applied to predict the likelihood of the examination being positive for breast cancer. The scheme performance was evaluated when applying to a retrospectively collected database including 80 malignant and 50 benign cases.

Results

In each of 91% of malignant cases and 66% of benign cases, the average contrast enhancement value computed from the top 0.43% of voxels is higher in the breast depicted suspicious lesions as compared to another negative (lesion-free) breast. In classifying between malignant and benign cases, using the computed image feature achieved an area under a receiver operating characteristic curve of 0.839 with 95% confidence interval of [0.762, 0.898].

Conclusions

We demonstrated that the global contrast enhancement feature of DCE-MRI can be relatively easily and robustly computed without accurate breast tumor detection and segmentation. This global feature provides supplementary information and a higher discriminatory power in assisting diagnosis of breast cancer.     

US screening for detection of nonpalpable locoregional recurrence after mastectomy

Purpose

To assess the value of screening ultrasonography (US) in the detection of nonpalpable locoregional recurrence following mastectomy for breast cancer and to describe the US appearances of occult recurrent cancers.

Materials and methods

During a 36-month period, 1180 consecutive US screenings were performed for mastectomy sites and ipsilateral axillary fossae in 468 asymptomatic women who had undergone mastectomy for breast cancer. All US results were divided into three groups: negative findings, probably benign nodules, and suspicious for malignant nodules. The final diagnoses were based on pathology results and clinical or sonographic follow-up for more than 12 months. The diagnostic performance of US for detecting nonpalpable locoregional recurrence was assessed. The US appearances of occult recurrent cancers were retrospectively reviewed.

Results

Of the 468 patients assessed, 19 (4.1%) showed “suspicious for malignant nodules”; of these lesions, 10 were malignant. One false-negative case was identified. The sensitivity and specificity were 90.9% and 98.0%, respectively. A biopsy positive predictive value of 52.6% was observed. Cancer detection rates were 2.1% with US screenings of mastectomy sites and ipsilateral axillary fossae. The common US features of occult recurrences at the mastectomy sites were irregular shaped, not-circumscribed marginated, and hypoechoic masses with intratumoral vascularities. The most common location was within the deep muscle layer.

Conclusion

Although locoregional recurrence infrequently occurs after mastectomy for breast cancer, screening US enables detection of nonpalpable cancer before it can be detected by clinical examination. Routine follow-up US can be advocated for early detection of nonpalpable locoregional recurrent cancer.     

Identification of occult breast lesions detected by magnetic resonance imaging with targeted ultrasound: A prospective study

Objective

To verify the capacity of targeted ultrasound (US) to identify additional lesions detected on breast magnetic resonance imaging (MRI), but occult to initial mammography, US and clinical examinations.

Methods

This prospective study included 68 additional relevant breast lesions identified on MRI of 49 patients. As an inclusion criterion, breast US and mammography were required and performed up to six months before MRI. These lesions were then subjected to targeted “second-look” US up to 2 weeks after MRI, performed by one or two radiologists with expertise on breast imaging. Lesions were evaluated according to the established Breast Imaging Report and Data System (BI-RADS) lexicon.

Results

Targeted US identified 46/68 (67.6%) lesions revealed by MRI. No significant associations were observed between US identification and the type of lesion, dimensions, morphological characteristics and enhancement pattern according to MRI findings. Targeted US identified 100% of BI-RADS category 5 lesions, 90% of category 4 lesions, and just over 50% of category 3 lesions (p < 0.05). There was significant agreement (p < 0.001) between MRI and US BI-RADS classification for all three categories.

Conclusion

Targeted US can identify a large proportion of the lesions detected by breast MRI, especially those at high risk of malignancy, when performed by a professional with experience in both breast US and MRI.     

Differentiating benign from malignant solid breast lesions: Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging

Objective

To prospectively evaluate the diagnostic efficacy of conventional ultrasound (US), contrast-enhanced US (CEUS), the combined use of two modalities, and magnetic resonance imaging (MRI) in the differentiation of focal solid breast lesions.

Materials and methods

61 patients with BI-RADS category 3–5 breast lesions detected at conventional US underwent CEUS and MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of conventional US, CEUS, combination of two modalities and MRI for discrimination between benign and malignant breast lesions.

Results

Tissue specimens of 61 breast lesions were obtained either from surgical resection (n = 46) or from needle biopsy (n = 15). Histopathologic diagnosis revealed 28 benign and 33 malignant lesions. The diagnostic performance of conventional US and CEUS in differentiating benign from malignant breast lesions showed no significant difference (P = 0.741). The combination of two modalities significantly improved the diagnostic accuracy compared with either conventional US or CEUS alone (P = 0.031 and P = 0.012, respectively). The area under the ROC curve (A_z) value for the combined use of two modalities for discrimination between benign and malignant breast lesions was 0.94, and that for MRI was 0.91, whereas no statistical difference was found between them (P = 0.296).

Conclusion

The combined use of conventional US and CEUS has a better diagnostic performance than either method alone and displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.     

Magnetic resonance spectroscopy in recurrent breast masses following conservative surgery and radiation therapy

Purpose

The purpose of our study was to assess the value of functional magnetic resonance spectroscopy (1H MRS) in evaluating patients with recurrent cancer breast after breast conservative therapy (BCT) and radiation therapy by the presence of the choline-containing compounds (Cho) as a marker of malignancy.

Patients and methods

Twenty-six patients were included in the study all the patients were subjected to previous BCT and associated radiation therapy. All of them were suspected to have tumor recurrence by clinical examinations, periodic mammographic examination and or ultrasonography. All the patients were submitted to dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) followed by magnetic resonance spectroscopy (MRS) at 1.5 T MRI machine.

Results

Local recurrence was confirmed by histopathology in 19 patients, MRS detected 18 patients with sensitivity of 94.7%, false positive was seen in one patient in whom histopathology revealed inflammatory mastitis (specificity 85.7%). One patient was false negative diagnosed by histopathology as ductal carcinoma in situ (DCIS) with negative predictive value of 85.7% and overall accuracy of 92.3%.

Conclusion

In our study breast MRS using choline (Cho) integral was accurate in evaluating patients with recurrent breast masses after BCT and radiation therapy. It reaches a high level of diagnostic performance.     

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

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.     

Extended Field-of-View Sonography: Evaluation of the Superficial Lesions

Objective

To evaluate the usefulness of extended-field-of-view 2-dimensional ultrasonography technique in superficial lesions.

Methods

During a 6-month period, 44 patients with superficial lesions on various parts of their bodies were evaluated with extended-field-of-view ultrasonography in addition to routine traditional 2-dimensional ultrasonography. If the diagnosis could not be made without the extended-field-of-view images, it was considered diagnostic. The radiologist decided if the extended-field-of-view ultrasonography helped spatial orientation, communicate findings, or compare the contralateral side in a single image, or if it was useful for follow-up evaluation.

Results

By using extended-field-of-view imaging including the surrounding anatomy, 22 musculoskeletal, 8 scrotal, 8 thyroid, 2 breast, and 4 abdominal wall lesions were documented successfully as a single image. Nevertheless, no new cases were diagnosed solely based on the extended-field-of-view images. Extended-field-of-view ultrasonography was considered helpful for spatial orientation in 25 cases (56.8%), for comparing the contralateral side in 16 cases (36.3%), and for communicating findings in 20 cases (45.4%). It was useful for follow-up evaluation in 13 cases (29.5%).

Conclusions

None of the extended-field-of-view images was diagnostic. However, they did provide valuable additional information and better documentation of the lesions.