Second look ultrasound: Effective MRI correlate for identifying incidental breast lesions

A second look ultrasound of the breast, used in conjunction with MRI, allows radiologists to identify lesions not detected on conventional mammography and first look ultrasound; in some cases it allows radiologists to determine whether or not a lesion is malignant or benign, according to a study performed at the University of Rome La Sapienza in Rome, Italy.

The study included 182 patients who had mammography, ultrasound and MRI. "More than 25% of all enhancing lesions detected on breast MRI were incidental enhancing lesions not seen on conventional imaging," said Federica Pediconi, MD, lead author of the study. "Breast MRI identified 55 additional lesions in 46/182 patients that were not seen on x-ray mammography or first look ultrasound. 21 lesions detected on breast MRI were confirmed as malignant. Second look ultrasound confirmed the presence of 42/55 lesions found on MRI. A total of 24 of the 42 lesions confirmed on ultrasound were malignant," she said.

"Based on our findings, second look ultrasound should be performed in all cases of incidental enhancing lesions found on breast MRI and not seen before. An incidental lesion with suspicious features on MRI and ultrasound is more likely to be malignant," said Dr. Pediconi.

"On the basis of our experiences, second look ultrasound is an optimal choice for the depiction and diagnoses of incidental enhancing lesions detected on preoperative MRI and allows for good patient management. Moreover, if a lesion is depicted with ultrasound it may be amenable to ultrasound-guided percutaneous biopsy which is cheaper and faster," she said.

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