Tissue harmonic imaging (THI) and contrast harmonic imaging (CHI) for sonographically guided vacuum-assisted biopsy of mammographically occult breast tumors

Abstract

To assess the guidance of tissue harmonic imaging (THI) and contrast harmonic imaging (CHI) for vacuum assisted biopsies of suspicious breast lesions compared to fundamental B-mode ultrasound-guided biopsies. In 550 patients, ultrasound examinations of the breast were performed prospectively using fundamental B-scan, THI, and CHI. Focal lesions were documented in comparable projections for all three ultrasound modes. As contrast agent, a dose of 0.5 milliliters of Perflutren Protein-Type A microspheres ( Optison) was injected. An ultrasound-guided biopsy was performed in 38 focal lesions. Three radiologists experienced in breast imaging retrospectively assessed the lesions on the ultrasound images. Thirty-eight suspicious focal lesions [size 4 - 15 mm; median 8 mm] were detected by ultrasound. Of these, 29 were detected by fundamental B-scan images, 34 by THI, and 38 by CHI. Ultrasound-guided biopsy was performed on all of these lesions. No complications related to the biopsy were observed. In 25/38 cases, invasive carcinomas were found; in 6/38 ductal carcinomas in situ; in 3 cases metastases of already known invasive ductal carcinomas; and in 4 cases fibroadenomas. The size of the lesion was best identified using THI, smaller lesions (< 10 mm) using CHI. THI and CHI can help to detect focal lesions in dense breasts. Both modes can make it easier to perform ultrasound-guided biopsies of focal breast lesions.