Paola Clauser MD, Presenter: Nothing to Disclose

Luca Alessandro Carbonaro MD, Abstract Co-Author: Research Consultant, im3D SpA

Martina Pancot, Abstract Co-Author: Nothing to Disclose

Massimo Bazzocchi MD, Abstract Co-Author: Nothing to Disclose

Chiara Zuiani MD, Abstract Co-Author: Nothing to Disclose

Francesco Sardanelli MD, Abstract Co-Author: Speakers Bureau, Bracco Group Research Grant, Bracco Group Speakers Bureau, Bayer AG Research Grant, Bayer AG Research Grant, IMS International Medical Scientific

To assess the clinical utility of second-look digital breast tomosynthesis (SL-DBT) to look for lesions detected initially on MRI and to compare SL-DBT with second-look ultrasound (SL-US).

This multicentric retrospective study included 143 patients with biopsy-proven breast cancer that underwent both BT and MRI as staging. The study obtained IRB approval and patients signed the informed consent for the examinations. Four readers with experience in breast imaging reviewed MRI examinations to find incidental lesions not suspected on the basis of previous imaging. MRI lesions characteristics were evaluated: morphology (mass like enhancement ML, non mass like enhancement NML or foci), dimensions (≤10 mm or > 10 mm) and ACR BIRADS classification (3 or 4-5). DBT was then re-evaluated looking for MRI findings. Data on SL-US were also collected for all incidental findings. Standard of reference was biopsy, surgical excision or follow up (≥1 year).

Eighty-two MRI incidental findings were detected in 51 patients. At SL-DBT a correlation was made in 40 cases (49%) including 29 malignant lesions and 11 benign lesions. At SL-US a correlation was made in 41 (50%) including 25 malignant and 16 benign lesions. Overall, 61 (74.4%) of the lesions were visible with at least one technique other than MRI, including 40 malignant and 21 benign lesions. Of the 21 lesions non-visible at second look, 17 were malignant and 4 were benign. When analysing the type of lesion found at SL-DBT, no significant differences were found regarding morphology (ML vs NML vs foci), dimensions (≤10 mm or > 10 mm) and BIRADS classification (3 vs 4-5). Though the difference was not significant, SL-DBT found more frequently NML lesions compared to SL-US (44% vs 28%).

SL-DBT allowed to add almost 25% additional lesions in adjunct to SL-US, and it could be particularly helpful for areas of NML enhancement. The absence of a DBT or US correlate does not warrant to avoid MR-guided biopsy for suspicious findings.

With the introduction of systems to perform biopsy under Tomosynthesis guidance, the use of SL-DBT could help avoiding MR-guided biopsy, thus reducing costs and discomfort for the patients.

Clauser, P, Carbonaro, L, Pancot, M, Bazzocchi, M, Zuiani, C, Sardanelli, F, Incidental Findings on Breast MRI: The Added Value of Second-look Digital Breast Tomosynthesis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045581.html