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Targeted ultrasound for MR-detected lesions in breast cancer patients.

Shin JH, Han BK, Choe YH, Ko K, Choi N - Korean J Radiol (2007 Nov-Dec)

Bottom Line: We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions.We also investigated their pathological outcomes and changes in treatment as a result of lesion identification.The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: To investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US.

Materials and methods: One-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification.

Results: Of the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision.

Conclusion: Targeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate.

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Related in: MedlinePlus

A 40-year-old woman with a 1 cm palpable cancer of the left breast.A, B. Dynamic enhanced and subtracted T1-weighted sagittal MR images show a 1 cm intensely enhancing main mass (arrow) (A) in addition to a 5 cm clumped segmental enhancement with washout (arrowheads) (B) in a different plane.C. A high signal intensity (arrowheads) of a 5 cm clumped segmental enhancement is noted on the reverse subtracted image.D. Initial US shows only a 1 cm hypoechoic mass (arrow) at a palpable site.E. Targeted US shows a normal-looking, but slightly heterogeneous parenchyma. We interpreted that the additional enhancing lesion on MR had no US correlate. On a frozen section examination during the surgical operation, the additional enhancing lesion at the surrounding parenchyma revealed a malignancy, which was confirmed as an extensive intraductal carcinoma with an invasive ductal carcinoma following mastectomy. The surgical plan was changed from conservative breast surgery to mastectomy without the consent of the patient.
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Figure 3: A 40-year-old woman with a 1 cm palpable cancer of the left breast.A, B. Dynamic enhanced and subtracted T1-weighted sagittal MR images show a 1 cm intensely enhancing main mass (arrow) (A) in addition to a 5 cm clumped segmental enhancement with washout (arrowheads) (B) in a different plane.C. A high signal intensity (arrowheads) of a 5 cm clumped segmental enhancement is noted on the reverse subtracted image.D. Initial US shows only a 1 cm hypoechoic mass (arrow) at a palpable site.E. Targeted US shows a normal-looking, but slightly heterogeneous parenchyma. We interpreted that the additional enhancing lesion on MR had no US correlate. On a frozen section examination during the surgical operation, the additional enhancing lesion at the surrounding parenchyma revealed a malignancy, which was confirmed as an extensive intraductal carcinoma with an invasive ductal carcinoma following mastectomy. The surgical plan was changed from conservative breast surgery to mastectomy without the consent of the patient.

Mentions: Of the 38 lesions examined with targeted US, 27 (71%) had a US correlate, which included 15 (56%, 15/27) cancers (Fig. 1), two (7%, 2/27) high-risk lesions (lobular carcinoma in situ and atypical ductal hyperplasia in each one) and ten (37%, 10/27) benign lesions (Fig. 2). Of the 11 lesions without a US correlate, three (27%, 3/11) proved to be cancerous (Fig. 3) and five (45%, 5/11) were benign as determined by mastectomy or breast conserving surgery with additional excision (Fig. 4), however, three (27%, 3/11) were not confirmed by histology. The cancer rate was statistically higher in lesions with a US correlate than in ones without a US correlate (p = 0.028) (Table 2). Of 15 cancers with a US correlate US, ten (67%) were confirmed as invasive ductal carcinoma, and five (33%) as ductal carcinoma in situ. Of the three cancers without a US correlate, two (67%) were ductal carcinoma in situ, and one (33%) as an invasive ductal carcinoma. The difference between invasive and in situ carcinoma was not statistically significant (p = 0.528). Of US correlate lesions identified by histology, the high-risk lesions included lobular carcinoma in situ and atypical ductal hyperplasia for each one. The benign lesions were diagnosed as papilloma in three, fibroadenoma, stromal fibrosis, fibrocystic disease in two each, and columnar cell change in one. Imaging findings and pathological results of US correlate lesions are summarized in Table 3.


Targeted ultrasound for MR-detected lesions in breast cancer patients.

Shin JH, Han BK, Choe YH, Ko K, Choi N - Korean J Radiol (2007 Nov-Dec)

A 40-year-old woman with a 1 cm palpable cancer of the left breast.A, B. Dynamic enhanced and subtracted T1-weighted sagittal MR images show a 1 cm intensely enhancing main mass (arrow) (A) in addition to a 5 cm clumped segmental enhancement with washout (arrowheads) (B) in a different plane.C. A high signal intensity (arrowheads) of a 5 cm clumped segmental enhancement is noted on the reverse subtracted image.D. Initial US shows only a 1 cm hypoechoic mass (arrow) at a palpable site.E. Targeted US shows a normal-looking, but slightly heterogeneous parenchyma. We interpreted that the additional enhancing lesion on MR had no US correlate. On a frozen section examination during the surgical operation, the additional enhancing lesion at the surrounding parenchyma revealed a malignancy, which was confirmed as an extensive intraductal carcinoma with an invasive ductal carcinoma following mastectomy. The surgical plan was changed from conservative breast surgery to mastectomy without the consent of the patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627449&req=5

Figure 3: A 40-year-old woman with a 1 cm palpable cancer of the left breast.A, B. Dynamic enhanced and subtracted T1-weighted sagittal MR images show a 1 cm intensely enhancing main mass (arrow) (A) in addition to a 5 cm clumped segmental enhancement with washout (arrowheads) (B) in a different plane.C. A high signal intensity (arrowheads) of a 5 cm clumped segmental enhancement is noted on the reverse subtracted image.D. Initial US shows only a 1 cm hypoechoic mass (arrow) at a palpable site.E. Targeted US shows a normal-looking, but slightly heterogeneous parenchyma. We interpreted that the additional enhancing lesion on MR had no US correlate. On a frozen section examination during the surgical operation, the additional enhancing lesion at the surrounding parenchyma revealed a malignancy, which was confirmed as an extensive intraductal carcinoma with an invasive ductal carcinoma following mastectomy. The surgical plan was changed from conservative breast surgery to mastectomy without the consent of the patient.
Mentions: Of the 38 lesions examined with targeted US, 27 (71%) had a US correlate, which included 15 (56%, 15/27) cancers (Fig. 1), two (7%, 2/27) high-risk lesions (lobular carcinoma in situ and atypical ductal hyperplasia in each one) and ten (37%, 10/27) benign lesions (Fig. 2). Of the 11 lesions without a US correlate, three (27%, 3/11) proved to be cancerous (Fig. 3) and five (45%, 5/11) were benign as determined by mastectomy or breast conserving surgery with additional excision (Fig. 4), however, three (27%, 3/11) were not confirmed by histology. The cancer rate was statistically higher in lesions with a US correlate than in ones without a US correlate (p = 0.028) (Table 2). Of 15 cancers with a US correlate US, ten (67%) were confirmed as invasive ductal carcinoma, and five (33%) as ductal carcinoma in situ. Of the three cancers without a US correlate, two (67%) were ductal carcinoma in situ, and one (33%) as an invasive ductal carcinoma. The difference between invasive and in situ carcinoma was not statistically significant (p = 0.528). Of US correlate lesions identified by histology, the high-risk lesions included lobular carcinoma in situ and atypical ductal hyperplasia for each one. The benign lesions were diagnosed as papilloma in three, fibroadenoma, stromal fibrosis, fibrocystic disease in two each, and columnar cell change in one. Imaging findings and pathological results of US correlate lesions are summarized in Table 3.

Bottom Line: We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions.We also investigated their pathological outcomes and changes in treatment as a result of lesion identification.The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: To investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US.

Materials and methods: One-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification.

Results: Of the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision.

Conclusion: Targeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate.

Show MeSH
Related in: MedlinePlus