Our Summary

This research paper discusses the discovery of breast lesions or abnormal areas of tissue, that were not found during mammography (breast X-ray) or ultrasonography (ultrasound imaging), but were spotted during preoperative MRI scans for breast cancer. These are often referred to as ‘MRI-only’ detected breast lesions. Currently, the recommended procedure for such lesions is an MRI-guided needle biopsy, but this method is expensive and not widely available in Japan.

The paper reviews two studies which tested a simpler method: third-look contrast-enhanced ultrasonography (CEUS) combined with a needle biopsy. This technique showed moderate to high sensitivity (meaning it was able to correctly identify those with lesions) and high specificity (meaning it correctly identified those without lesions). The method was particularly effective for MRI-only lesions that were categorized as more severe on the MRI BI-RADS scale (a scale used to assess breast cancer risk).

While the literature review has its limitations, the paper suggests that CEUS combined with needle biopsy is a feasible and more readily accessible diagnostic tool for MRI-only detected breast lesions. This technique could potentially reduce the need for MRI-guided needle biopsies. However, if the third-look CEUS doesn’t reveal the MRI-only lesions, a further MRI-guided needle biopsy might still be necessary, depending on the severity of the lesion according to the BI-RADS category.

FAQs

  1. What are ‘MRI-only’ detected breast lesions?
  2. What is the recommended procedure for ‘MRI-only’ detected breast lesions and why might it not be ideal?
  3. How does the third-look contrast-enhanced ultrasonography (CEUS) combined with a needle biopsy method work and what are its potential benefits?

Doctor’s Tip

A doctor might advise a patient undergoing a breast biopsy to discuss with their healthcare provider the possibility of using third-look contrast-enhanced ultrasonography (CEUS) combined with a needle biopsy, especially if the lesion was only detected on an MRI scan. This technique has shown promising results in correctly identifying breast lesions and could potentially be a more accessible and cost-effective alternative to MRI-guided needle biopsies. It is important to follow up with additional testing or procedures as recommended by your healthcare provider to ensure an accurate diagnosis and appropriate treatment plan.

Suitable For

Patients who are typically recommended for breast biopsy include those with:

  1. Suspicious findings on mammography, such as microcalcifications or a mass.
  2. Abnormalities detected on ultrasound, such as a solid mass or complex cyst.
  3. MRI-only detected lesions that are not visible on mammography or ultrasound.
  4. Personal or family history of breast cancer.
  5. Previous breast biopsy with abnormal results.
  6. Symptoms such as a lump, nipple discharge, or breast pain.
  7. Changes in the breast tissue detected during a clinical breast exam.

It is important for patients to discuss their individual risk factors and concerns with their healthcare provider to determine if a breast biopsy is necessary.

Timeline

Before the breast biopsy:

  1. Patient undergoes a routine mammogram or ultrasound which detects a suspicious area in the breast.
  2. Patient may undergo a preoperative MRI scan to further evaluate the abnormal area.
  3. MRI scan reveals MRI-only detected breast lesion that was not seen on mammogram or ultrasound.
  4. Patient is recommended for a biopsy to determine the nature of the lesion.

After the breast biopsy:

  1. Patient undergoes a third-look contrast-enhanced ultrasonography (CEUS) combined with a needle biopsy as a simpler and more accessible diagnostic tool.
  2. CEUS helps in identifying the presence of the lesion and determining the severity based on the BI-RADS scale.
  3. If the lesion is not detected on CEUS, a MRI-guided needle biopsy may still be necessary.
  4. Results of the biopsy determine the nature of the lesion and guide further treatment options for the patient.

What to Ask Your Doctor

Some questions a patient should consider asking their doctor about breast biopsy include:

  1. What is the reason for recommending a breast biopsy?
  2. What type of biopsy will be performed (needle biopsy, surgical biopsy, etc.)?
  3. What are the potential risks and side effects of the biopsy procedure?
  4. How long will it take to receive the biopsy results?
  5. What will happen if the biopsy results show cancer or another abnormality?
  6. Are there any alternative diagnostic procedures or treatments available?
  7. Will I need to undergo additional tests or imaging before the biopsy?
  8. How experienced is the healthcare team in performing breast biopsies?
  9. Will I need to follow any specific instructions before or after the biopsy?
  10. How will the biopsy results be communicated to me, and what support services are available for further discussions or treatment options?

Reference

Authors: Miyake T, Shimazu K. Journal: J Med Ultrason (2001). 2024 Oct;51(4):599-604. doi: 10.1007/s10396-023-01298-8. Epub 2023 Mar 11. PMID: 36905491