3D Automated breast ultrasound (ABUS): pictorial review of applications and clinical utility.

Transcription

1 3D Automated breast ultrasound (ABUS): pictorial review of applications and clinical utility. Poster No.: C-1182 Congress: ECR 2013 Type: Educational Exhibit Authors: A. Domingo, C. Cusido, F. V. Gras, X. Salvador Izquierdo ; Tarragona/ES, Barcelona/ES Keywords: Cancer, Education, Ultrasound, Breast DOI: /ecr2013/C-1182 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 30

2 Learning objectives To review the potential applications of ABUS such as detection and characterization of benign and malignant lesions, evaluation of breast implants and its complications (i.e. rupture), screening of asymptomatic dense-breasted women, amongst others. Background Mammography is the accepted gold standard for breast screening. However, the sensitivity is as low as 40% in dense-breasted women. Hand-held breast ultrasound (HHUS) has been proved to be an important adjunct to mammography in the evaluation of breast lesions, specially in this last group of women. HHUS is a relatively available, inexpensive and well-tolerated method. However, HHUS is an examiner-dependent and time consuming method. The examiner has to be present at the time of acquisition. HHUS requires time and skills, the results depending mostly on the radiologist's skills. The recent introduction of ABUS offers a standarized technique (Fig. 2 and 3) performed by less trained personal (radiographers), allowing thus more efficient time for the physicians to interpret the studies, at a convenient time, while being free of doing the scan. ABUS is generally well tolerated by patients. The introduction of ABUS provides additional information to the examiner. The coronal plane offers an easily understandable representation of the breast's anatomy, specially useful in breast surgery. The use of ABUS allows multiplanar reconstructions in coronal, transverse and sagittal views from the automated data set. The multiplanar views provide additional information in the differential diagnosis of a lesion, increasing the diagnostic accuracy and lesion size prediction. The rate of second-look ultrasounds is due to the loss of ability to explore the patient, and explore further a lesion modifying certain parameters (compression, Doppler, elastography). The radiologist's training reduces the second-look US due to technical artifacts. Page 2 of 30

3 The combined use of screening mammography and ABUS doubles overall cancer detection and triples detection of small invasive cancers in dense-breasted women. Images for this section: Fig. 1 Page 3 of 30

4 Fig. 2: Standard scan protocol (3 planes). Page 4 of 30

5 Fig. 3: Special scan protocol (5 planes). Page 5 of 30

6 Imaging findings OR Procedure details The use of tridimensional images allows the radiologist to improve the accuracy in the diagnosis of focal breast lesions, both benign and malignant. Variables such as mass size, surrounding tissue changes, margins, site, and shape of the mass can be evaluated in multiplanar views, thus giving a more accurate diagnosis. We review the findings and patterns in a variety of focal breast lesions, the correlation with adjunct mammography and anatomopathologic findings. The use of ABUS helps to evaluate breast implants and its potential complications in 3D reconstruccions, providing the surgeons a comprehensive and detailed full view of the breast. Figures 4 to 11 show a selection of illustrative malignant breast lesions from 6 different cases. Multiplanar correlation in axial, coronal and sagittal planes and mammography are shown. Figure 12 shows a post-operative scar in a patient with history of previous carcinoma. Multiplanar reconstructions in coronal plane with correlation in the axial plane are shown. Figures 13 to 20 show a selection of benign focal breast lesions, including biopsy-proven fibroadenomas and cystic mastopathy. Figures 21 and 22 show benign axillar and intra-mammary lymph nodes represented in coronal and sagittal views. Figures 23 to 25 are examples of ruptured breast implants in multiplanar reconstructions. Figure 26 represents a false positive of ABUS. Images for this section: Page 6 of 30

7 Fig. 4: 52 y/o with palpable mass. Right breast mammography (top left), coronal (top right), axial (bottom left) and sagittal (bottom right) images are shown. A hypoechoic irregular mass with spiculated growth pattern can be appreciated. Biopsy revealed invasive ductal carcinoma. Page 7 of 30

8 Fig. 5: 49 y/o woman with palpable mass. The right breast mammography (top right) shows a small dense irregular nodule, corresponding to a small, hypoechoic, with irregular margins mass. Spiculated growth pattern can be appreciated in the coronal views (bottom left). The biopsy was consistent with invasive ductal carcinoma. Page 8 of 30

9 Fig. 6: 35 y/o woman with palpable mass. Axial images (top and bottom left) show a hypoechoic lobulated mass with an ill-defined margin and intense accoustic shadowing. The coronal images (top right) demonstrate intense desmoplastic reaction. Bottom right note corresponding mammography. Biospy proven invasive carcinoma. Page 9 of 30

10 Fig. 7: Figures 7 and 8 corresponding to the same patient. 36 y/o breast-feeding woman. Palpable axillar mass. Right breast mammography and coronal and sagittal reconstructions show a multifocal carcinoma, best seen in the coronal plane. Page 10 of 30

11 Fig. 8: Continuation. Page 11 of 30

12 Fig. 9: 55 y/o woman who underwent routine ABUS. Coronal (top) and axial (bottom) images show a small hypoechoic mass, ill-defined, with irregular margins and internal hyperechoic foci. Note in the coronal plane spiculated growth pattern. The biopsy confirmed invasive carcinoma. Page 12 of 30

13 Fig. 10: 52 y/o woman who underwent routine screening mammography and ABUS. Left breast mammography (top) shows a dense distorted area behind the nipple. Corresponding US axial image shows a diffuse hypoechoic area with no clear associated mass. Biopsy confirmed invasive ductal carcinoma. Page 13 of 30

14 Fig. 11: 74 y/o woman who underwent screening mammography showing a small dense nodule (not shown). Corresponding ABUS in axial (top and right bottom) and coronal (left) shows multifocal ductal invasive carcinoma. Page 14 of 30

15 Fig. 12: Post-operative scar in a 53 y/o woman with a history of breast cancer. Axial (bottom) plane shows an irregular hypoechoic mass with accoustic shadowing. Note spiculated growth pattern and retraction in the coronal plane, secondary to post-operative changes. Page 15 of 30

16 Fig. 13: 19 y/o woman with palpable mass. Axial (top), coronal (left bottom) and sagittal (right bottom) images show an echogenic well demarcated mass with accoustic enchancement consistent with biopsy proven fibroadenoma. Page 16 of 30

17 Fig. 14: Biopsy proven fibroadenoma in an asymptomatic 35 y/o old woman. Coronal (top) and axial (bottom)images show small lobulated hypoechoic mass. Page 17 of 30

18 Fig. 15: 34 y/o who underwent routine ABUS. Coronal (top right) and axial images (top left and bottom) demonstrate a well defined, regular, hypoechoic mass consistent with biopsy proven fibroadenoma in the left upper lateral quadrant. Complicated cyst is shown in the axial plane (bottom center). Page 18 of 30

19 Fig. 16: Figures 15 and year old woman with palpable mass in the right upper medial quadrant not seen at mammography (figure 15). Corresponding ABUS in coronal and axial planes (figure 16) show asmall well defined hypoechoic mass. Biopsy proven fibroadenoma. Fig. 17: Figures 15 and year old woman with palpable mass in the right upper medial quadrant not seen at mammography (figure 15). Corresponding ABUS in coronal Page 19 of 30

20 and axial planes (figure 16) show asmall well defined hypoechoic mass. Biopsy proven fibroadenoma. Fig. 18: Cystic mastopathy in a 36 y/o dense-breasted woman. Small hyperechoic foci are seen in the sagittal view (left), consistent with microcalcifications. Page 20 of 30

21 Fig. 19: Asymptomatic 33 y/o woman with dense breast. Axial (bottom) and coronal (top) images show multiple anechoic lesions correponding with cysts and a well demarcated hypoechoic lesion consistent with fibroadenoma. Page 21 of 30

22 Fig. 20: Small cysts in asymptomatic dense-breast woman. Page 22 of 30

23 Fig. 21: 45 y/o asymptomatic woman. Sagittal (left) and axial (right) images show an illdefined mass with hyperechoic centre. Handheld ultrasound confirmed intra-mammary lymph-node. Sagittal view shows artifact movement. Page 23 of 30

24 Page 24 of 30

25 Fig. 22: 25 y/o woman who presented for screening breast ultrasound. Coronal (top) and axial (bottom) images show a benign axillar lymph node. Fig. 23: 35 y/o woman with breast implants who presented with breast pain. ABUS in multiplanar reconstructions in axial (left) and coronal planes (right). US images show diffuse and irregular capsule thickening and low-level internal echoes. MRI confirmed intracapsular rupture. Page 25 of 30

26 Fig. 24: 31 y/o woman who complained breast pain. Irregular capsule thickening and internal echoes are demonstrated in sagittal (left), axial (top right) and coronal (bottom right) planes. MRI confirmed rupture. Page 26 of 30

27 Fig. 25: 29 y/o woman who presented for screening breast ultrasound. Axial (top) and coronal (bottom) images are shown. In the axial plane double echogenic lines that course parallel to surface are shown (stepladder sign). Internal echoes are demonstrated in both planes. MRI confirmed rupture. Page 27 of 30

28 Fig. 26: Ill-defined hypoechoic region with accoustic shadowing behind de nipple in an asymptomatic 35 y/o woman. Mammography shows a dense breast. Handheld ultrasound proved no lesion, thus resulting in a false ABUS positive. Page 28 of 30

29 Conclusion ABUS represents a potential diagnostic tool, especially in dense-breasted women. It provides additional information in the evaluation of focal lesions with multiplanar reconstructions, increasing diagnostic accuracy and offering visualization of the whole breast. It guarantees high patient safety as there is no exposure to ionizing radiation and no injection of contrast medium. References 1. KM Kelly, J Dean, WS Comulada, SJ Lee. Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. European radiology, Springer. 2. Woo Kyung Moon, Yi-Wei Shen, Chiun-Sheng Huang, Sheng-Chy Luo, Aida Kuzucan, Jeon-Hor Chen, Ruey-Feng Chang. Comparative study of density analysis using automated whole breast ultrasound and MRI. Med Phys January; 38(1): Published online 2010 December Jung Min Chang, Woo Kyung Moon, Nariya Cho, Jeong Seon Park, Seung Ja Kim. Radiologists' performance in the detection of benign and malignant masses with 3D automated breast ultrasound (ABUS). European Journal of Radiology. Volume 78, Issue 1, Pages , April Chang JM, Moon WK, Cho N, Park JS, Kim SJ. Breast cancers initially detected by hand-held ultrasound: detection performance of radiologists using automated breast ultrasound data. Acta Radiol Feb 1;52(1): Wang ZL, Xw JH, Li JL, Huang Y, Tang J. Comparison of automated breast volume scanning to hand-held ultrasound and mammography. Radiol Med Dec;117(8): Epub 2012 Jun Kotsianos D, Wirth S, Fischer T, Hiltawsky K, Sittek H, Reiser M. 3D ultrasound (3D US) in the diagnosis of focal breast lesions. Radiologe Mar;45(3): Page 29 of 30

30 7. Wenkel E, Heckmann M, Heinrich M, Schwab SA, Uder M, Schulz-Wendtland R, Bautz WA, Janka R. Automated breast ultrasound: lesion detection and BI-RADS classification--a pilot study. Rofo Sep;180(9): Kelly KM, Dean J, Lee SJ, Comulada WS. Breast cancer detection: radiologists' performance using mammography with and without automated whole-breast ultrasound. Eur Radiol Nov;20(11): Lin X, Wang J, Han F, Fu J, Li A. Analysis of eighty-one cases with breast lesions using automated breast volume scanner and comparison with handheld ultrasound. Eur J Radiol May;81(5): Prosch H, Halbwachs C, Strobl C, Reisner LM, Hondl M, Weber M, Mostbeck GH. Automated breast ultrasound vs. handheld ultrasound: BI-RADS classification, duration of the examination and patient comfort. Ultraschall Med Oct;32(5): Wojcinski S, Farrokh A, Hille U, Wiskirchen J, Gyapong S, Soliman AA, Degenhardt F, Hillemanns P. The Automated Breast Volume Scanner (ABVS): initial experiences in lesion detection compared with conventional handheld B-mode ultrasound: a pilot study of 50 cases. Int J Womens Health. 2011;3: Personal Information Page 30 of 30