Giovanna Mariscotti, Abstract Co-Author: Nothing to Disclose

Manuela Durando, Presenter: Nothing to Disclose

Mirella Fasciano, Abstract Co-Author: Nothing to Disclose

Giulia Schivazappa, Abstract Co-Author: Nothing to Disclose

Davide Bosco, Abstract Co-Author: Nothing to Disclose

Elisa Regini, Abstract Co-Author: Nothing to Disclose

Chiara Ruggieri, Abstract Co-Author: Nothing to Disclose

Paolo Fonio, Abstract Co-Author: Nothing to Disclose

Giovanni Gandini MD, Abstract Co-Author: Nothing to Disclose

To review our institutional experience in using DBT as SL in the evaluation of additional enhancing lesions identified on preoperative breast MRI.

From June 2009 to January 2013, 520 patients with breast cancers detected on DM and ultrasound (US) and confirmed by cytology/histology underwent preoperative MRI. In 114 patients, MRI detected 164 additional lesions: all the patients underwent SL US who identified 114/164 (69.5%) MRI additional lesions. 50/164 (30.5%) lesions not seen on US underwent SL DM+DBT (the patients, who signed an informed consent, had mammographic two standard views in Combo mode (DM and DBT acquisition within a single compression) on the interested breast). Subsequently to SL DM+DBT, re-targeted US evaluation was performed. Focusing on SL DM+DBT, we compared morphological features, size and BI-RADS-MRI classification of additional MRI findings and DBT lesions features. Suspicious additional lesions were confirmed by percutaneous biopsy or surgical excision. Imaging follow-up (range 6-12 months) was used for probably benign lesions, not biopsied.

SL DM+DBT identified 32/50 (64%) of MRI additional lesions (mean size 10.2±6.2 mm), of which 28/50 (56%) were classified as BI-RADS-MR4 and 22/50 (44%) as MR3. Considering the MRI morphological features of the 32 lesions depicted by SL DM+DBT, 15/32 (46.9%) were non mass-like, 9/32 (28.1%) mass-like and 8/32 (25%) foci. At SL DM+DBT, lesions were 13/32 (40.6%) small masses, 8/32 (25.0%) asymmetric densities with microcalcifications and 11/32 (34.4%) architectural distortions. Of these lesions, 24/32 were subsequently detected on re-targeted US and biopsied under US guidance if suspicious (8/24, 33.3% were cancer). 8/32 lesions were detected only by SL DM+DBT and biopsied under stereotactic guidance if suspicious (2/8, 25% were cancer). Of the 18/50 additional lesions not identified by SL DM+DBT, 2/18 were MR4 (underwent MRI-guided biopsy, resulting atypical ductal hyperplasia) and 16/18 MR3 (all cases sent to follow-up, resulting disease-free).

Second-look DM+DBT was helpful in the clinical work-up of additional lesions detected on preoperative breast MRI, particularly for non mass-like enhancement.

In our preliminary experience, the clinical work-up of the additional enhancing lesions detected on preoperative breast MRI was implemented by second-look with Digital Breast Tomosynthesis.

Mariscotti, G, Durando, M, Fasciano, M, Schivazappa, G, Bosco, D, Regini, E, Ruggieri, C, Fonio, P, Gandini, G, Role of Digital Breast Tomosynthesis (DBT) Combined with Digital Mammography (DM) in Second-look (SL) for the Evaluation of Additional Lesions Detected on Preoperative Breast Magnetic Resonance Imaging (MRI): Preliminary Experience.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13024473.html