Evaluation of the intramammary distribution of breast lesions detected by MRI but not conventional second- look B-mode ultrasound using an MRI/ultrasound fusion technique

doi:10.21203/rs.3.rs-4200864/v1

Download PDF

Research Article

Evaluation of the intramammary distribution of breast lesions detected by MRI but not conventional second- look B-mode ultrasound using an MRI/ultrasound fusion technique

https://doi.org/10.21203/rs.3.rs-4200864/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 01 Aug, 2024

Read the published version in BMC Medical Imaging →

You are reading this latest preprint version

The objective of this study was to evaluate the intramammary distribution of MRI-detected mass and focus lesions that were difficult to identify with conventional B-mode ultrasound (US) alone. Consecutive patients with lesions detected with MRI but not second-look conventional B-mode US were enrolled between May 2015 and June 2023. Following an additional supine MRI examination, we performed second-look US using real-time virtual sonography (RVS), an MRI/US image fusion technique. We divided the distribution of MRI-detected mammary gland lesions as follows: center of the mammary gland versus other (superficial fascia, deep fascia, and atrophic mammary gland). We were able to detect 27 (84%) of 32 MRI-detected lesions using second-look US with RVS. Of these 27 lesions, 5 (19%) were in the center of the mammary gland and 22 (81%) were located in other areas. We were able to biopsy all 27 lesions; 8 (30%) were malignant and 19 (70%) were benign. Histopathologically, three malignant lesions were invasive ductal carcinoma (IDC; luminal A), one was IDC (luminal B), and four were ductal carcinoma in situ (low-grade). Malignant lesions were found in all areas, with no statistical differences in frequency between the center of the mammary gland and other areas (p = 0.601). In this study, 81% of the lesions identified using second-look US with RVS were located outside the center of the mammary gland. Thus, we consider it important to carefully examine other areas for breast lesions when performing second-look US when a lesion has been detected with MRI but not with second-look conventional B-mode US.

real-time virtual sonography

MRI-detected lesion

second-look ultrasound

breast cancer

Magnetic resonance imaging (MRI) of the breast is a useful tool for detecting breast cancer. MRI is increasingly used to assess symptoms, screen women at high risk for breast cancer, stage known breast cancers, and screen the contralateral breast in patients with newly diagnosed breast cancer (1, 2). Several authors have questioned the utility of preoperative MRI, given the possibility of overdiagnosis or false-positives (3, 4). However, others have reported that MRI can reliably predict tumor progression, especially in very dense breasts (5).

The specificity and moderate positive predictive value of MRI can limit its effectiveness. A recent meta-analysis about using preoperative MRI to detect multifocal or multicentric cancers in the ipsilateral breast showed that the rate of additional cancer foci being detected ranged from 6–34%; the median was 16% and the positive predictive value was 66% (6). Thus, breast biopsy is necessary in order to definitively diagnose suspicious lesions, especially in MRI-detected lesions that are not detected on initial mammography. When lesions detected with MRI are also detected with second-look ultrasound (US), US-guided biopsy is recommended.

Second-look US has detection rates that vary substantially (7). Few studies have reported the distribution of MRI-detected breast lesions. Moreover, it is difficult to identify all lesions because examination success depends on the sonographer’s experience and skill. Furthermore, lesion characterization with breast US has poor reproducibility, which remains a clinical challenge.

MRI-guided biopsy has been developed over the past several years to help diagnose conventional B-mode–occult breast lesions detected with MRI. Compared with other modalities, MRI-guided biopsies are less accurate (8–10). Moreover, target sampling is more difficult after MRI-guided biopsy than after biopsy with ultrasound or stereotactic guidance. Radiopathologic correlation after MRI-guided biopsy is particularly challenging when MRI lesions only enhance in vivo and their presence cannot be confirmed in the biopsy specimen, even when biopsy markers have been appropriately placed (8).

Real-time virtual sonography (RVS) is an MRI/US image fusion technique introduced in 2005. RVS combines real-time sonography with MRI, allowing for the display of images from both imaging modalities on the same monitor. During sonography, the RVS system identifies the probe’s position and movement. It simultaneously reconstructs an equivalent MRI image from previously imported volume data. If a lesion that was initially detected with prone MRI cannot be identified during second-look conventional B-mode US, we add supine MRI and perform second-look US using RVS. Regarding breast deformation, tumor displacement during MRI results from discrepancies between positions during supine versus prone examination. A previous study showed that the probe can be positioned at the MRI-enhancing target lesion with RVS without any special US operator experience or the presence of landmarks. Second-look US with RVS is associated with improved sonographic and histopathologic detection rates of occult lesions detected with conventional B-mode US (11–14).

Satake et al. reported that tumor displacement in the breast during MRI due to prone versus supine positioning varies by tumor location. It is most common in the inner lower quadrant (15). Carbonaro et al. reported that lesion-to-nipple distance might be the most reliable measure for second-look breast US (16). However, few studies have evaluated the intramammary distribution of MRI-detected lesions identified with second-look US using RVS. The objective of this study was to evaluate the intramammary distribution of MRI-detected mass and focus lesions that were difficult to identify with conventional B-mode US alone.

Patients and lesions

This study was approved by the institutional review board of Aichi Medical University Hospital (No. 2022 − 125). The need for written informed consent was waived for this research study. Consecutive patients with one or more MRI-detected lesions that were not identified with second-look conventional B-mode US between May 2015 and June 2023 were enrolled in this study. Second-look US using RVS was performed to identify these lesions. Non–mass enhancement (NME) was excluded from this study because of the difficulty in objectively assessing them. US-guided biopsy was performed for MRI-detected lesions detected with RVS; additional excisional biopsy was performed if necessary.

Prone MRI

Prone MRI was used for preoperative assessment or to evaluate abnormal findings further. A dedicated double-breast coil was used with a 1.5-T scanner (Magnetom, Siemens Medical Systems, Erlangen, Germany)(11–14, 17, 19).

Second-look conventional B-mode US

After prone MRI, a 13-MHz linear array probe (HI VISION Ascendus, ARIETTA 850; Hitachi Aloka Medical, Tokyo, Japan) was used for second-look conventional B-mode US with the patient in the supine and arm-up position (11–14, 17, 19). It was performed by experienced surgeons routinely involved in breast cancer treatment.

Supine MRI

When a lesion initially detected with prone MRI was not identified with second-look conventional B-mode US, supine MRI was added to acquire the data necessary for US using RVS. Supine MRI with a 1.5-T scanner (Magnetom, Siemens Medical Systems) was performed with the arm raised (11–14, 17, 19). A flexible body surface coil was used to achieve the same position as that used in US (11, 17). Acquisition was performed as described previously. For evaluation of lesion size, type (focus, mass, or NME), and kinetic curve assessment, we used Breast Imaging Reporting and Data System (BI-RADS) criteria (18).

Second-look US using RVS

Second-look US using RVS was performed in the supine and arm-up position (Fig. 1a, b). The RVS system consisted of an US scanner, magnetic field generator, magnetic sensor, and workstation with built-in RVS software (Hitachi Aloka Medical). (11–14, 19, 20). RVS was found to be superior for identifying iso-echogenic lesions and lesions within a heterogeneous background echotexture around the mammary fascia or deep within the breast parenchyma (12, 21).

RVS-guided biopsy

When MRI-detected lesions were identified with RVS, US-guided biopsy was performed. Core needle biopsy (CNB) was performed with a 16-gauge spring-loaded automatic core needle (Monopty; C.R. Bard, Covington, GA, USA). Vacuum-assisted biopsy (VAB) was performed with an 11-gauge needle (Mammotome; Ethicon Endo-Surgery, Cincinnati, OH, USA) (11–14, 17, 19). If the result of CNB or VAB was high-risk atypical ductal hyperplasia, preoperative RVS-guided marking and excisional biopsy were performed; the final histopathological classification was based on this biopsy sample (11).

Pathological criteria for invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC)

IDC and ILC subtypes were determined according to hormonal receptor (HR) status, Ki-67 status, and HER-2 status (19).

Pathological criteria for ductal carcinoma in situ (DCIS)

DCIS subtype was classified as low-, intermediate-, or high-grade based on the features of the nuclei of the neoplastic cells (22).

Intramammary distribution of MRI-detected lesions

We divided the distribution of MRI-detected mammary gland lesions located from the skin to the pectoralis major muscle into four regions: adjacent to the superficial mammary fascia (s area), adjacent to the deep mammary fascia (d area), center of the mammary gland (c area), and atrophic mammary gland (a area) (Fig. 2) (12).

Statistical analysis

Data were statistically analyzed using BellCurve for Excel (Social Survey Research Information, Tokyo, Japan). The mean tumor size of MRI-detected lesions was compared using the t-test. The χ² test was used to compare other categorical variables. The significance level was set at p < 0.05.

This study included 32 women (median age, 57 years; range, 41–73) with 32 lesions (22 mass lesions and 10 focus lesions) detected with MRI but not with second-look conventional B-mode US. Second-look US using RVS was able to detect 27 (84%) of these 32 lesions (19 [86%] of 22 mass lesions and 8 [80%] of 10 focus lesions). Table 1 shows the MRI characteristics of the MRI-detected lesions. Table 2 shows the MRI and US characteristics of the benign and malignant lesions. There were significant differences on US in orientation (p = 0.031) and margin (p = 0.031) between benign and malignant lesions.

The intramammary distribution of benign and malignant lesions is shown in Table 3. Of these, 16 were located around the mammary fascia (9 [33%] in s area and 7 [26%] in d area), 5 (19%) in c area, and 6 (22%) in a area. Of the 21 lesions not located in a area, where the mammary gland was atrophic and the landmarks were not obvious, 16 (76%) were located around the mammary fascia, i.e., in the marginal part of the mammary gland. When we performed a statistical analysis of whether benign or malignant lesions were distributed in c area (19%) versus other areas (81%), there were no significant differences (p = 0.601). In addition, there were no significant differences in intramammary distribution (s, c, d, and a areas) between benign and malignant lesions (p = 0.955). Figures 3–6 show cases located in each of the four areas.

We were able to perform RVS-guided biopsy of all 27 lesions detected by second-look US using RVS. CNB and excisional biopsy were performed, respectively, in 17 (63%) and 10 (37%) of the 27 lesions overall. This corresponded to 13 (68%) and 6 (32%) of the 19 mass lesions and 4 (50%) and 4 (50%) of the 8 focus lesions, respectively. Of the 27 lesions, 8 (30%) were malignant, which consisted of 5 of 19 (26%) mass lesions and 3 of 8 (38%) focus lesions.

The histopathological results of the malignant lesions were IDC (luminal A) in three lesions (all focus lesions), IDC (luminal B) in one mass lesion, and DCIS (low-grade) in four (all mass lesions). The histopathological results of benign lesions were mastopathy in 3, intraductal papilloma in 2, atypical ductal hyperplasia in 1, atypical lobular hyperplasia and hemangioma in 1, and other in 12. Malignant lesions were located in all areas: around the mammary fascia in 63% (s area in 3 [38%] lesions, d area in 2 [25%] lesions), c area in 1 (13%) lesion, and a area in 2 (25%) lesions.

In this study, 27 (84%) of 32 MRI-detected lesions were able to be detected. Of these 27 lesions, 16 were around the mammary fascia (9 [33%] in s area and 7 [26%] in d area), 5 (19%) were in c area, and 6 (22%) were in a area. Of 21 lesions not located in a area, where the mammary gland was atrophic and the landmarks were not obvious, 16 (76%) were located in s and d areas, which correspond to the marginal part of mammary gland that has minimal contrast with its surrounding tissue. Malignant lesions were present in all areas, with no significant differences in their intramammary distribution (p = 0.955). We were able to biopsy all 27 lesions, of which 8 (30%) were malignant and 19 (70%) were benign. The histopathological results of the malignant lesions, which were located in all areas, were IDC (luminal A) (n = 3), IDC (luminal B) (n = 1), and DCIS (low-grade) (n = 4). On the basis of these results, we consider it important to thoroughly assess the margins of the mammary gland during second-look US for MRI-detected lesions.

While second-look US is inexpensive, radiation-free, and useful for identifying breast lesions detected with MRI, Spick and Baltzer found wide variation in the general detection rate for second-look US, ranging from 22.6–82.1% (7). Other authors have noted that findings on second-look US were subtle, necessitating careful scanning techniques for successful MRI/US correlation (23, 24). Furthermore, there is no direct evidence that lesions detected on MRI can be detected and biopsied accurately (14) whereas no special US operator skill or experience is needed to perform RVS. In terms of objectivity and reproducibility, second-look US with MRI/US fusion techniques is considered superior to second-look conventional B-mode US (11–14, 17, 19, 20, 25–30).

Differences in posture between examinations in supine versus prone position cause lesion displacement. Aribal et al. reported that an abbreviated supine sequence following a standard prone dynamic contrast-enhanced diagnostic MRI with one administration of contrast was useful for identifying lesion locations (31). They also reported that lesion displacement along the chest wall is correlated with breast size but not with the amount of fibroglandular tissue. Breast size and lesion displacement relative to the distance from the sternum or nipple were not correlated. Carbonaro et al. (16) reported that prone MRI resulted in lesion displacement of 30–60 mm in three orthogonal directions relative to supine MRI. Considering that the mean position error for RVS is approximately 12 mm, morphological findings can be directly compared between US and supine MRI (13). Moreover, RVS provides accurate information about position even in the absence of landmarks identified with US and MRI. Recent studies have demonstrated the utility of second-look US using RVS that synchronizes MRI and US images with respect to the nipple on the side being examined (24, 32).

In this study, the RVS-guided biopsy detection rate for malignant lesions was 30%. According to the BI-RADS classification system (18), the rate with MRI-guided biopsy is 20–50%. Thus, RVS-guided biopsy can be a promising substitute for MRI-guided breast biopsy, but further study is needed.

MRI-guided biopsy is challenging because of various technical issues (33, 34). First, it is expensive and time-consuming, for patients and radiologists alike. Second, it requires specialized equipment (35). In contrast, special equipment is not needed for RVS-guided biopsy and it is less expensive (24). Furthermore, the average turnaround time for RVS-guided biopsy is 25 minutes, which is shorter than the turnaround time for MRI-guided biopsy because the supine breast MRI protocol used in RVS can be shortened (24). The increased use of RVS relative to MRI might be beneficial in terms of cost, time, and availability. RVS can also help determine whether an MRI-guided biopsy is absolutely necessary.

This study had several limitations. First, it was a retrospective investigation with a relatively small number of patients. Additional prospective studies with more patients are needed. Second, supine breast MRI using a body surface coil is affected by artifacts related to movements during breathing as well as heartbeats. Low coil filling factor leads to poor image quality. Therefore, it is not a firmly established method to diagnose breast cancer. Additional research should be performed to evaluate the accuracy of the method.

Second-look US using RVS was able to detect 84% of MRI-detected mass and focus lesions that could not be identified with second-look conventional B-mode US. It was used to evaluate the intramammary distribution of these lesions. Fifty-nine percent of MRI-detected mass or focus lesions were located around the mammary fascia, where the contrast with the surrounding tissue was small. Malignant lesions were present in all areas; there were no significant differences in their intramammary distribution. We consider it important to carefully examine the region around the mammary fascia when performing second-look US for mass and focus lesions detected with MRI.

MRI magnetic resonance imaging

US ultrasound

RVS real-time virtual sonography

NME non-mass enhancement

DICOM Digital Imaging and Communications in Medicine

BI-RADS Breast Imaging Reporting and Data System

CNB core needle biopsy

VAB vacuum-assisted biopsy

IDC invasive ductal carcinoma

ILC invasive lobular carcinoma

HR hormonal receptor

DCIS ductal carcinoma in situ

Ethics approval and consent to participate

This preliminary retrospective study was approved by the institutional review board of Aichi Medical University Hospital (approval number, 2022–125). Standard written informed consent was obtained at the time of the procedure. The need for informed consent was waived for this retrospective study. All procedures were performed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Consent for publication

Not applicable.

Availability of data and materials

All data used in this study are available from the corresponding author upon reasonable request.

Competing interests

The authors have no conflicts of interest to declare.

Funding

No funding was received for this work.

Authors' contributions

MS participated in the design of the study and acquisition of data, performed statistical analysis, and drafted the manuscript. SN made contributions to study conception and design. All authors participated in revising the manuscript critically for important intellectual content and gave final approval of the version to be published. All authors read and approved the final manuscript.

Acknowledgments

None.

Kuhl CK. Current status of breast MR imaging. Part 2. Clinical applications. Radiology. 2007;244(3):672–91.
Morris EA. Diagnostic breast MR imaging: current status and future directions. Radiol Clin North Am. 2007;45(5):863–80. vii.
Burki TK. Preoperative MRI in breast cancer. Lancet Oncol. 2015;16(15):e530.
Parsyan A, Moldoveanu D, Balram B, Wong S, Zhang DD, Svadzian A, et al. Influence of preoperative magnetic resonance imaging on the surgical management of breast cancer patients. Am J Surg. 2016;211(6):1089–94.
Debald M, Abramian A, Nemes L, Dobler M, Kaiser C, Keyver-Paik MD, et al. Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer. Breast Cancer Res Treat. 2015;153(3):531–7.
Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26(19):3248–58.
Spick C, Baltzer PA. Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 2014;273(2):401–9.
Dratwa C, Jalaguier-Coudray A, Thomassin-Piana J, Gonin J, Chopier J, Antoine M, et al. Breast MR biopsy: Pathological and radiological correlation. Eur Radiol. 2016;26(8):2510–9.
Park HL, Hong J. Vacuum-assisted breast biopsy for breast cancer. Gland Surg. 2014;3(2):120–7.
Spick C, Schernthaner M, Pinker K, Kapetas P, Bernathova M, Polanec SH, et al. MR-guided vacuum-assisted breast biopsy of MRI-only lesions: a single center experience. Eur Radiol. 2016;26(11):3908–16.
Nakano S, Yoshida M, Fujii K, Yorozuya K, Mouri Y, Kousaka J, et al. Fusion of MRI and sonography image for breast cancer evaluation using real-time virtual sonography with magnetic navigation: first experience. Jpn J Clin Oncol. 2009;39(9):552–9.
Nakano S, Kousaka J, Fujii K, Yorozuya K, Yoshida M, Mouri Y, et al. Impact of real-time virtual sonography, a coordinated sonography and MRI system that uses an image fusion technique, on the sonographic evaluation of MRI-detected lesions of the breast in second-look sonography. Breast Cancer Res Treat. 2012;134(3):1179–88.
Nakano S, Yoshida M, Fujii K, Yorozuya K, Kousaka J, Mouri Y, et al. Real-time virtual sonography, a coordinated sonography and MRI system that uses magnetic navigation, improves the sonographic identification of enhancing lesions on breast MRI. Ultrasound Med Biol. 2012;38(1):42–9.
Watanabe R, Ando T, Osawa M, Ido M, Kousaka J, Mouri Y, et al. Second-look US Using Real-time Virtual Sonography, a Coordinated Breast US and MRI System with Electromagnetic Tracking Technology: A Pilot Study. Ultrasound Med Biol. 2017;43(10):2362–71.
Satake H, Ishigaki S, Kitano M, Naganawa S. Prediction of prone-to-supine tumor displacement in the breast using patient position change: investigation with prone MRI and supine CT. Breast Cancer. 2016;23(1):149–58.
Carbonaro LA, Tannaphai P, Trimboli RM, Verardi N, Fedeli MP, Sardanelli F. Contrast enhanced breast MRI: spatial displacement from prone to supine patient's position. Preliminary results. Eur J Radiol. 2012;81(6):e771–4.
Goto M, Nakano S, Saito M, Banno H, Ito Y, Ido M et al. Evaluation of an MRI/US fusion technique for the detection of non-mass enhancement of breast lesions detected by MRI yet occult on conventional B-mode second-look US. J Med Ultrason (2001). 2022;49(2):269 – 78.
ACR BI-RADS atlas. Breast imaging reporting and data system : mammography, ultrasound, magnetic resonance imaging, follow-up and outcome monitoring, data dictionary. 5th ed. ed: American College of Radiology; 2013.
Ando T, Ito Y, Ido M, Osawa M, Kousaka J, Mouri Y, et al. Pre-Operative Planning Using Real-Time Virtual Sonography, an MRI/Ultrasound Image Fusion Technique, for Breast-Conserving Surgery in Patients with Non-Mass Enhancement on Breast MRI: A Preliminary Study. Ultrasound Med Biol. 2018;44(7):1364–70.
Nakano S, Ando T, Tetsuka R, Fujii K, Yoshida M, Kousaka J, et al. Reproducible surveillance breast ultrasound using an image fusion technique in a short-interval follow-up for BI-RADS 3 lesions: a pilot study. Ultrasound Med Biol. 2014;40(6):1049–57.
Park AY, Seo BK, Han H, Cho KR, Woo OH, Cha SH, et al. Clinical Value of Real-Time Ultrasonography-MRI Fusion Imaging for Second-Look Examination in Preoperative Breast Cancer Patients: Additional Lesion Detection and Treatment Planning. Clin Breast Cancer. 2018;18(4):261–9.
Komforti MK, Harmon BE. Educational Case: Ductal Carcinoma In Situ (DCIS). Acad Pathol. 2019;6:2374289519888727.
Abe H, Schmidt RA, Shah RN, Shimauchi A, Kulkarni K, Sennett CA, et al. MR-directed (Second-Look) ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings. AJR Am J Roentgenol. 2010;194(2):370–7.
Uematsu T, Takahashi K, Nishimura S, Watanabe J, Yamasaki S, Sugino T, et al. Real-time virtual sonography examination and biopsy for suspicious breast lesions identified on MRI alone. Eur Radiol. 2016;26(4):1064–72.
Aribal E, Tureli D, Kucukkaya F, Kaya H. Volume Navigation Technique for Ultrasound-Guided Biopsy of Breast Lesions Detected Only at MRI. AJR Am J Roentgenol. 2017;208(6):1400–9.
Fausto A, Fanizzi A, Volterrani L, Mazzei FG, Calabrese C, Casella D et al. Feasibility, Image Quality and Clinical Evaluation of Contrast-Enhanced Breast MRI Performed in a Supine Position Compared to the Standard Prone Position. Cancers (Basel). 2020;12(9).
Uematsu T. Real-time virtual sonography (RVS)-guided vacuum-assisted breast biopsy for lesions initially detected with breast MRI. Jpn J Radiol. 2013;31(12):826–31.
Fausto A, Rizzatto G, Preziosa A, Gaburro L, Washburn MJ, Rubello D, et al. A new method to combine contrast-enhanced magnetic resonance imaging during live ultrasound of the breast using volume navigation technique: a study for evaluating feasibility, accuracy and reproducibility in healthy volunteers. Eur J Radiol. 2012;81(3):e332–7.
Fausto A, Bernini M, La Forgia D, Fanizzi A, Marcasciano M, Volterrani L, et al. Six-year prospective evaluation of second-look US with volume navigation for MRI-detected additional breast lesions. Eur Radiol. 2019;29(4):1799–808.
Kucukkaya F, Aribal E, Tureli D, Altas H, Kaya H. Use of a Volume Navigation Technique for Combining Real-Time Ultrasound and Contrast-Enhanced MRI: Accuracy and Feasibility of a Novel Technique for Locating Breast Lesions. AJR Am J Roentgenol. 2016;206(1):217–25.
Aribal E, Bugdayci O. Supplementary abbreviated supine breast MRI following a standard prone breast MRI with single contrast administration: is it effective in detecting the initial contrast-enhancing lesions? Diagn Interv Radiol. 2019;25(4):265–9.
Kang DK, Jung Y, Han S, Kim JY, Kim TH. Clinical Utility of Real-Time MR-Navigated Ultrasound with Supine Breast MRI for Suspicious Enhancing Lesions Not Identified on Second-Look Ultrasound. Ultrasound Med Biol. 2017;43(2):412–20.
Brennan SB. Breast magnetic resonance imaging for the interventionalist: magnetic resonance imaging-guided vacuum-assisted breast biopsy. Tech Vasc Interv Radiol. 2014;17(1):40–8.
Price ER. Magnetic resonance imaging-guided biopsy of the breast: fundamentals and finer points. Magn Reson Imaging Clin N Am. 2013;21(3):571–81.
Nakashima K, Uematsu T, Harada TL, Takahashi K, Nishimura S, Tadokoro Y, et al. MRI-detected breast lesions: clinical implications and evaluation based on MRI/ultrasonography fusion technology. Jpn J Radiol. 2019;37(10):685–93.

Table 1 to 3 are available in the Supplementary Files section.

No competing interests reported.

table.pptx

Download PDF

Journal Publication

published 01 Aug, 2024

Read the published version in BMC Medical Imaging →

Editorial decision: Revision requested
04 Jun, 2024
Reviews received at journal
25 May, 2024
Reviews received at journal
15 May, 2024
Reviewers agreed at journal
04 May, 2024
Reviews received at journal
02 May, 2024
Reviewers agreed at journal
19 Apr, 2024
Reviewers agreed at journal
17 Apr, 2024
Reviewers invited by journal
13 Apr, 2024
Editor invited by journal
03 Apr, 2024
Submission checks completed at journal
03 Apr, 2024
Editor assigned by journal
03 Apr, 2024
First submitted to journal
01 Apr, 2024

You are reading this latest preprint version

Evaluation of the intramammary distribution of breast lesions detected by MRI but not conventional second- look B-mode ultrasound using an MRI/ultrasound fusion technique

Status:

Journal Publication

Version 1

Abstract

Figures

Background

Methods

Patients and lesions

Prone MRI

Second-look conventional B-mode US

Supine MRI

Second-look US using RVS

RVS-guided biopsy

Pathological criteria for invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC)

Pathological criteria for ductal carcinoma in situ (DCIS)

Intramammary distribution of MRI-detected lesions

Statistical analysis

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Journal Publication

Version 1