Supine breast US: how to correlate breast lesions from prone MRI

To evaluate spatial displacement of breast lesions from prone MR to supine ultrasound positions, and to determine whether the degree of displacement may be associated with breast density and lesion histotype.

380 patients underwent breast MR and second-look ultrasound. The MR and ultrasound lesion location within the breast gland, distances from anatomical landmarks (nipple, skin and pectoral muscle), spatial displacement (distance differences from the landmarks within the same breast region) and region displacement (breast region change) were prospectively evaluated. Differences between MR and ultrasound measurements, association between the degree of spatial displacement and both breast density and lesion histotypes were calculated.

In 290/380 (76%) patients, 300 MR lesions were detected. 285/300 (95%) lesions were recognized on ultrasound. By comparing MR and ultrasound, spatial displacement occurred in 183/285 (64.3%) cases while region displacement in 102/285 (35.7%) cases with a circumferential movement along an arc centred on the nipple, having supine ultrasound as the reference standard. A significant association between the degree of lesion displacement and breast density was found (p < 0.00001) with a significant higher displacement in case of fatty breasts. No significant association between the degree of displacement and lesion histotype was found (p = 0.1).

Lesion spatial displacement from MRI to ultrasound may occur especially in adipose breasts. Lesion-nipple distance and circumferential displacement from the nipple need to be considered for ultrasound lesion detection.

Second-look ultrasound breast lesion detection could be improved by calculating the lesion-nipple distance and considering that spatial displacement from MRI occurs with a circumferential movement along an arc centred on the nipple.