Technological advances in the local evaluation and treatment of breast cancer
| Technique | Past | Present | Future |
|---|---|---|---|
| Definition of ductal anatomy | Contrast radiography | Direct endoscopic visualization | Intraductal excision of lesions |
| Breast cancer screening | Film mammography | Digital mammography | Possibly digital tomosynthesis |
| Preoperative evaluation of the extent of disease | Film mammography, ultrasonography | Digital mammography with computer-assisted detection, ultrasonography, MRI in selected circumstances | Possibly digital, tomosynthesis, ultrasonography, MRI |
| Breast-conserving surgery | Palpation | Wire localization | Molecular probes |
| Surgical specimen evaluation | Gross and microscopic evaluation | Orientation of specimen, inking of margins, specimen radiograph, directed sectioning | 3-D specimen imaging and imaging–pathology correlation |
| Axillary staging | Axillary node dissection | Sentinel lymph node biopsy | Preoperative imaging of axillary nodes +/− biopsy, sentinel lymph node biopsy |
| Tumour classification | Histologic type, size | Grade, lymphovascular invasion, ER, PR, Her2-neu oncogene expression | Genotyping |
| Gene expression | ER, PR | ER, PR, Her2-neu expression, Mammaprint,* Oncotype DX* | Gene array–based individualized treatment |
| Radiotherapy | Whole-breast radiation | Conformal whole-breast radiation | Partial-breast radiation |
3-D = 3-dimensional; ER = estrogen receptor; PR = progesterone receptor; MRI = magnetic resonance imaging.
↵* Clinical trial.