Dear Editor,<\/p>\n
We were very interested to read the letter from Dr. Erkin Aribal comprising an intriguing comment on our article [1]. Nevertheless, we feel it is important to note several inaccuracies of interpretation in it.<\/p>\n
Firstly, we should like to stress the fact that, as shown in Table 2, in our study 76% (549\/722) of the additional lesions detected with contrast-enhanced breast MRI proved visible on second-look US, while for 21% (151\/722)\u2014and not 87.3% as stated in Dr. Aribal\u2019s letter\u2014the performance of second-look US with MRI Volume Navigation (V Nav) was required to obtain the histological proof.<\/p>\n
Moreover, in the course of the follow-up, the administration of contrast medium three times before obtaining diagnostic definition was required in only one patient: hence in 0.7% of the cases, 1\/151, and not 12.7% of patients as reported in the letter. We do not feel that this frequency\u2014namely 1 lesion in 1 patient in 6 years\u2014can be considered relevant.<\/p>\n
It should also be stressed that the rate of re-biopsy of US-guided biopsy was 0.5% of the cases, 3\/549, which, compared with that of the US-guided biopsy with V Nav, proves insignificant (p=ns).<\/p>\n
As regards the question of MRI-guided biopsy, it is important to clarify what is reported in our article: that 3% (22\/722) of all additional lesions detected with breast MRI, negative at second-look US, were subjected directly to MRI-guided biopsy since they were cases of breast hypertrophy.<\/p>\n
Finally, the hypothesis of performing a supplemental supine sequence (i.e. T1-weighted without fat suppression or without the chance to obtain a subtraction) after the dynamic study in prone position, could seem reasonable, irrespective of the number of cases verified in our study. However, in our opinion, this could present two different problems:<\/p>\n
As reported in our study [1], US-guided biopsies with V Nav were performed both when the lesions were visible in the US and MRI images and when they were visible only in the MRI images.<\/p>\n
We should like to conclude this letter with a last consideration stemming from these interesting observations. Perhaps a complete change of perspective could be useful: performing the breast MRI with contrast medium directly in a supine position, as suggested by Siegler P et al [4]. Such a change of paradigm would definitely save MRI room time and save on the administration of contrast media.<\/p>\n
Only further studies will tell us whether the two MRIs are equivalent in terms of diagnostic efficacy and feasibility.<\/p>\n","protected":false},"excerpt":{"rendered":"
Dear Editor, We were very interested to read the letter from Dr. Erkin Aribal comprising an intriguing comment on our article [1]. Nevertheless, we feel it is important to note several inaccuracies of interpretation in it. Firstly, we should like to stress the fact that, as shown in Table 2, in our study 76% (549\/722) […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","inline_featured_image":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-876","post","type-post","status-publish","format-standard","hentry","category-opinions"],"acf":[],"yoast_head":"\n