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Second-look US identification prior to guided biopsy.


Second Look US after Breast MRI or CESM. Lesion identification before biopsy.

Dr Luc ROTENBERG, RPO – ISHH. Radiologie Paris Ouest. Institut du Sein Henri Hartmann – Neuilly Sur Seine. Hôpital Franco-Britannique – Levallois-Perret 92

In case of doubt about an MRI or CESM image, a targeted ultrasound of “2nd look” allows in 50% to 90% of cases to find the lesion even if it was not visible on the first. Indications of breast MRI or CESM coupled with mammography and ultrasound, accurate cartography of breast lesion at the time of diagnosis an participate in the assessment of treatment strategy.
The sensitivity of MRI and CESM in high-risk patients or locally advanded lesion is between 61% and 86% while the mammogram does not exceed 33% to 36%. Their specificity is 90 to 95%.
The goals of breast MRI and/or CESM at the time of diagnosis include accurate balance and mapping of lesions. Size, location, uni or multifocal, multicentric, bilaterality, macroscopic lymph nodes assessment and guided biopsy after 2nd look Ultrasound.It participates in the strategic decision of treatment before surgery and chemotherapy neo adjuvant (CNA). The reading of MRI is inseparable from mammography and ultrasound.
Tailored prebiopsy counseling may better prepare women for percutaneous breast biopsy and improve their overall experience. Therefore, 2nd-look US is a useful tool that enables US-guided biopsy for lesions detected at MR imaging as a part of ballistic and pre-biopsy consultation.

  • understanding the differences in breast position and the underlying basic principles for each imaging modality is essential to ensure the concordance.
  • When detecting target at 2nd-look US in correlation with MR imaging: location, depth, characteristics, and appearance of the surrounding tissue, must be considered.
  • Various US techniques can be incorporated with B-mode US to identify subtle lesions.
  • The lack of a US correlate does not obviate biopsy. MR imaging–guided biopsy must be performed for lesions detected at MR imaging that have suspicious imaging features.
  • Follow up assessment if benign lesion.

The interpretation is done in synergy with an assessment of all the modalities to conclude in a concordant way and classify according to Birads on all the examinations to appreciate the conduct to be held, biopsy indication and modalities. Finally, treatment strategy can be modified in up to 33% after pre-treatment MRI/CESM and additional biopsy after 2nd look US.

  • October 20, 2023