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Is there a role for contrast-enhanced ultrasound in the detection and biopsy of MRI only visible breast lesions?

Aki Nykänen
Aki Nykänen
, 
Otso Arponen
Otso Arponen
, 
Anna Sutela
Anna Sutela
, 
Ritva Vanninen
Ritva Vanninen
 and 
Mazen Sudah
Mazen Sudah
   | Nov 29, 2017
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Article Category: Research Article
Published Online: Nov 29, 2017
Page range: 386 - 392
Received: Aug 17, 2017
Accepted: Oct 02, 2017
DOI: https://doi.org/10.1515/raon-2017-0049
© 2017 Aki Nykänen, Otso Arponen, Anna Sutela, Ritva Vanninen, Mazen Sudah
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

53 year old female patient with invasive carcinoma of the right breast. MRI detected an occult, BI-RADS 5, oval, 20×16 mm irregular mass lesion in the lower medial quadrant of the left breast (not shown). Targeted US (A) was negative. Contrast-enhanced ultrasound (B) revealed a 21 mm enhancement. Core biopsies were obtained from the enhancement area (C, ARROW) showing the core biopsy needle’s position). Both core biopsy and final histology showed high grade invasive carcinoma.
53 year old female patient with invasive carcinoma of the right breast. MRI detected an occult, BI-RADS 5, oval, 20×16 mm irregular mass lesion in the lower medial quadrant of the left breast (not shown). Targeted US (A) was negative. Contrast-enhanced ultrasound (B) revealed a 21 mm enhancement. Core biopsies were obtained from the enhancement area (C, ARROW) showing the core biopsy needle’s position). Both core biopsy and final histology showed high grade invasive carcinoma.

Figure 2

60 year old female patient with invasive carcinoma of no specific type (NST) of the left breast (not shown). MRI detected an occult BI-RADS 4 oval, 7×5 mm mass lesion in the upper medial quadrant of the right breast (A-C) thin slice multiplanar reconstruction in axial, coronal and sagittal orientations). Targeted US was negative (D). Contrast-enhanced ultrasound (E, ARROW) revealed a 5 mm round enhancement. Low grade ductal carcinoma in situ (DCIS) was diagnosed in the core biopsy of the enhanced lesion. The final histology was both DCIS (6×4 mm) and low grade invasive carcinoma NST (6×5 mm) in close vicinity.
60 year old female patient with invasive carcinoma of no specific type (NST) of the left breast (not shown). MRI detected an occult BI-RADS 4 oval, 7×5 mm mass lesion in the upper medial quadrant of the right breast (A-C) thin slice multiplanar reconstruction in axial, coronal and sagittal orientations). Targeted US was negative (D). Contrast-enhanced ultrasound (E, ARROW) revealed a 5 mm round enhancement. Low grade ductal carcinoma in situ (DCIS) was diagnosed in the core biopsy of the enhanced lesion. The final histology was both DCIS (6×4 mm) and low grade invasive carcinoma NST (6×5 mm) in close vicinity.

Patients, indications for MRI and MRI-only detected lesions’ characteristics, interventions and histopathological diagnosis

CaseAge yrsIndication for MRIOccult-lesion characteristics on MRIOccult lesion sizeCEUS visualizationInterventionCB and final histopathological diagnosis and size of lesion
171Preoperative local stagingMass, round, circumscribed, washout kinetic curve6 mmPositiveCEUS-guided CBCB: Low grade DCIS Final: Low grade DCIS. 3 mm
278Problem solvingMass, oval, circumscribed, washout kinetic curve7 mmNegativeMRI-guided localizationFinal: Papilloma. 5 mm
364Incidental breast lesion on CTNME, focal, heterogeneous20 mmNegativeUS-guided CBCB: high grade DCIS. Final: high grade DCIS.16 mm
454Preoperative local stagingMass, round, circumscribed, heterogeneous, washout kinetic curve7 mmPositiveCEUS-guided clip placementFinal: Intermediate grade IC NST. 5 mm
554Axillary metastasis from an occult breast cancerMass, irregular, not circumscribed, plateau kinetic curve12 mmNegativeMRI-guided CBVAB: Carcinoma with medullary feature Final: Carcinoma with medullary feature and high grade DCIS.10 mm
666Problem solvingMass, round, circumscribed, ring like enhancement, persistent kinetic curve5 mmPositiveCEUS-guided CB. Follow-upCB: Fibrocystic lesion, liponecrosis
730Problem solvingNME, focal, heterogeneous10 mmNegativeFollow-up--
861Preoperative local stagingMass, oval, irregular, washout kinetic curve10 mmPositiveCEUS-guided CBCB: Low grade DCIS Final: low grade IC NST 6 mm and Low grade DCIS 5mm
953Preoperative local stagingMass, oval, irregular, washout kinetic curve16 mmPositiveCEUS-guided CBCB: High grade IC NST Final: High grade IC NST. 13 mm
1065Axillary recurrenceMass, oval, circumscribed, homogeneous, persistent kinetic curve9 mmNegativeMRI-guided VABVAB: High grade DCIS + suspected microinvasion

Breast MRI protocol

SequenceTR/TE (ms)in-plane resolution mmSlice thickness (mm)Scanning time
T1-FFE4.57/2.30.48 × 0.480.76 min 11 s
T2-TSE5000/1200.6 × 0.623 min 20 s
STIR5000 /601 × 125 min 40 s
T1 dynamic

eTHRIVE spectrally adiabatic inversion recovery (SPAIR) fat suppression; pre-contrast and six phases after the gadoterate meglumine (0.2 ml/kg, 3 ml/s) injection followed by a saline chaser; FFE = fast field echo; STIR = Short tau inversion recovery; TSE = turbo spin echo

4.67/ 2.310.96 × 0.96158.5 s
DWI

#DWI = Diffusion weighted echo planar imaging with five respective b factors (0, 200, 400, 600 and 800 s/mm2);

7168 /951.15 × 1.154min 8 s
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