The value of second-look ultrasonography for magnetic resonance imaging-detected suspicious breast lesions in patients with breast cancer

The value of second-look ultrasonography for breast cancer




Breast cancer, magnetic resonance imaging, ultrasonography


Objective: Breast magnetic resonance imaging (b-MRI) is a highly sensitive diagnostic tool for detecting breast cancer (BC), but its relatively low specificity often requires tissue sampling. This study aimed to assess the utility and efficacy of second-look ultrasound (SLUS) in evaluating incidentally enhancing lesions (IELs) identified by preoperative contrast-enhanced breast MRI (CE-bMRI) and to review our institutional experience.

Methods: The study enrolled histopathologically proven invasive BC patients, who underwent preoperative CE-bMRI for cancer staging and were scanned with SLUS for IELs detected on MRI. The lesions’ imaging features and morphological analyses were assessed using the Breast Imaging and Reporting and Data System (BI-RADS). According to the BI-RADS classification, IELs considered Category 3 or 4 and had a suspicious correlate on SLUS were biopsied immediately.

Results: Additional IELs were detected in 121 of 352 (34.37%) patients on preoperative CE-bMRI, which was performed for staging. One hundred thirteen lesions were SLUS-correlated. BI-RADS Category 2 and 3 lesions were managed conservatively, while Category 4 lesions were biopsied under imaging guidance. The majority of the IELs were ipsilateral with known BC (61.00%), unifocal (62.26%), and showed mass enhancement, classified as BI-RADS 4 (57.23%) with indistinct and spiculated margins (71.68%). SLUS yielded a detection rate of 68.59%.

Conclusion: SLUS may be a valuable tool in evaluating lesions initially detected in breast MRI and can help reduce unnecessary biopsies.


Warner E, Messersmith H, Causer P, Eisen A, Shumak R, Plewes D. Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med. 2008; 148:671–9.

Ryu HH, Kim EY, Park YL, Park CH. The predictive value of second-look ultrasound after preoperative breast magnetic resonance imaging. J Breast Dis. 2015;3:65–70.

Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248–58.

Hellerhoff K, Dietrich H, Schinner R, Rjosk-Dendorfer D, Sztrókay-Gaul A, Reiser M, et al. Assessment of MRI-detected breast lesions: A benign correlate on second-look ultrasound can safely exclude malignancy. Breast Care (Basel). 2021;16:435–43.

Jobsen JJ, van der Palen J, Ong F, Meerwaldt JH. Synchronous, bilateral breast cancer: prognostic value and incidence. Breast. 2003;12:83-8.

Heron DE, Komarnicky KT, Hyslop T, Schwartz GF, Mansfield CM. Bilateral breast carcinoma: risk factors and outcomes for patients with synchronous and metachronous disease. Cancer. 2000; 88:2739–50.

Hungness ES, Safa M, Shaughnessy EA, Aron BS, Gazder PA, Hawkins HH, et al. Bilateral synchronous breast cancer: mode of detection and comparison of histologic features between the 2 breasts. Surgery. 2000;128:702–7.

Kim TH, Kang DK, Jung YS, Kim KS, Yim H. Contralateral enhancing lesions on magnetic resonance imaging in patients with breast cancer: Role of second-look sonography and imaging findings of synchronous contralateral cancer. J Ultrasound Med. 2012;31:903–13.

Wu WP, Chen CY, Lee CW, Wu HK, Chen ST, Wu YT, et al. Impact of pre-operative breast magnetic resonance imaging on contralateral synchronous and metachronous breast cancer detection-A case control comparison study with 1468 primary operable breast cancer patients with mean follow-up of 102 months. PLoS One. 2021;16:e0260093.

Perlet C, Heywang-Kobrunner SH, Heinig A, Sittek H, Casselman J, Anderson I, et al. Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Cancer. 2006;106:982–90.

Hong MJ, Cha JH, Kim HH, Shin HJ, Chae EY, Shin JE, et al. Second-look ultrasonography for MRI-detected suspicious breast lesions in patients with breast cancer. Ultrasonography. 2015;34:125–32.

Park VY, Kim MJ, Kim E-K, Moon HJ. Second-look US: How to find breast lesions with a suspicious MR imaging appearance. Radiographics. 2013;33:1361–75.

Abe H, Schmidt RA, Shah RN, Shimauchi A, Kulkarni K, Sennett CA, et al. MR-directed (“Second-Look”) ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings. AJR Am J Roentgenol. 2010;194:370–7.

Alikhassi A, Li X, Au F, Kulkarni S, Ghai S, Allison G, et al. False-positive incidental lesions detected on contrast-enhanced breast MRI: clinical and imaging features. Breast Cancer Res Treat. 2023;198:321-34.

Kolta M, Clauser P, Kapetas P, Bernathova M, Pinker K, Helbich TH, et al. Can second-look ultrasound downgrade MRI-detected lesions? A retrospective study. Eur J Radiol. 2020;127:108976.

Mazzei MA, Di Giacomo L, Fausto A, Gentili F, Mazzei FG, Volterrani L. Efficacy of Second-Look Ultrasound with MR Coregistration for Evaluating Additional Enhancing Lesions of the Breast: Review of the Literature. Biomed Res Int. 2018:1–8.

Jeon T, Kim YS, Son HM, Lee SE. Tips for finding magnetic resonance imaging-detected suspicious breast lesions using second-look ultrasonography: a pictorial essay. Ultrasonography. 2022;41:624-32.

Linda A, Zuiani C, Londero V, Bazzocchi M. Outcome of initially only magnetic resonance mammography-detected findings with and without correlate at second-look sonography: distribution according to patient history of breast cancer and lesion size. Breast. 2008;17:51–7.

Kwon YG, Park AY. Scoring System to Predict Malignancy for MRI-Detected Lesions in Breast Cancer Patients: Diagnostic Performance and Effect on Second-Look Ultrasonography. Taehan Yongsang Uihakhoe Chi. 2020;81:379-94.

Candelaria R, Fornage BD. Second-look US examination of MRdetected breast lesions. J Clin Ultrasound. 2011;39:115-21.

Demartini WB, Eby PR, Peacock S, Lehman CD. Utility of targeted sonography for breast lesions that were suspicious on MRI. AJR Am J Roentgenol. 2009;192:1128-34.

Meissnitzer M, Dershaw DD, Lee CH, Morris EA. Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol. 2009;193:1025-9.

Giannakeas V, Lim DW, Narod SA. The risk of contralateral breast cancer: a SEER-based analysis. Br J Cancer. 2021;125:601–10.

Tong J, Tan D, Ma J, Hu Y, Li M. Nomogram to predict contralateral breast cancer risk in breast cancer survivors: A SEER-based study. Medicine (Baltimore). 2021;100:e27595.

Ramin C, Withrow DR, Davis Lynn BC, Gierach GL, Berrington de González A. Risk of contralateral breast cancer according to first breast cancer characteristics among women in the USA, 1992-2016. Breast Cancer Res. 2021;23:24.




How to Cite

Aydın Aksu, S. (2023). The value of second-look ultrasonography for magnetic resonance imaging-detected suspicious breast lesions in patients with breast cancer: The value of second-look ultrasonography for breast cancer. The Injector, 2(3), 229–239.