title: Additional findings at preoperative breast MRI: the value of second-look digital breast tomosynthesis.
abstract: OBJECTIVE
  To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US).
  
  
  METHODS
  We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; ≤10 mm or >10 mm in size; BI-RADS 3, 4, or 5. DM and DBT exams were reviewed looking for MRI AFs; data on SL-US were collected. Reference standard was histopathology or ≥12-month negative follow-up. Fisher exact test and McNemar test were used.
  
  
  RESULTS
  Eighty-four AFs were detected in 53/135 patients (39%, 95%CI 31-48%). A correlate was found for 44/84 (52%, 95%CI 41-63%) at SL-US, for 20/84 (24%, 95%CI 11-28%) at SL-DM, for 42/84 (50%, 95%CI 39-61%) at SL-DBT, for 63/84 (75%, 95%CI 64-84%) at SL-DBT, and/or SL-US, the last rate being higher than for SL-US only, overall (p < 0.001), for mass or non-mass, ≤ or >10 mm, BI-RADS 4 or 5, or malignant lesions (p < 0.031). Of 21 AFs occult at both SLs, 17 were malignant (81%, 95%CI 58-94%).
  
  
  CONCLUSIONS
  When adding SL-DBT to SL-US, AFs detection increased from 52% to 75%. MR-guided biopsy is needed for the remaining 25%.
  
  
  CONCLUSIONS
  • Detection rate of MRI AFs using SL-US was 52% • Adding SL-DBT, the detection rate of MRI AFs significantly increased to 75%. • Over 80% of the remaining 25% MRI AFs were malignant. • MR-guided biopsy should be used when SL-US and SL-DBT are inconclusive.
authors.affiliation: Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, Azienda Ospedaliero-Universitaria, "S.Maria della Misericordia", Udine, Italy, clauser.p@hotmail.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Clauser
authors.forename: Luca A
authors.initials: LA
authors.lastname: Carbonaro
authors.forename: Martina
authors.initials: M
authors.lastname: Pancot
authors.forename: Rossano
authors.initials: R
authors.lastname: Girometti
authors.forename: Massimo
authors.initials: M
authors.lastname: Bazzocchi
authors.forename: Chiara
authors.initials: C
authors.lastname: Zuiani
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D014056:Tomography, X-Ray / Q000379:methods; D016217:Ultrasonography, Mammary / Q000379:methods