Skip to main content

Advertisement

Log in

Incorporating new imaging models in breast cancer management

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Mammography is the only screening test proven to decrease breast cancer morbidity and mortality. Although mammography is an effective screening tool, it does have limitations, particularly in women with dense breasts. New imaging techniques are emerging to overcome these limitations and enhance cancer detection, improving patient outcome. Digital mammography, computer aided detection, breast ultrasound and breast magnetic resonance imaging (MRI) are frequently used adjuncts to mammography in today’s clinical practice. Recent studies have shown that these techniques can enhance the radiologist’s ability to detect cancer and assess disease extent, which is crucial in treatment planning and staging. Positron emission tomography (PET) also plays an important role in staging breast cancer and monitoring treatment response. Other modalities such as tomosynthesis and MR lymphangiography show promise in overcoming the problems related to dense breast tissue and the lack of noninvasive methods to assess lymph node status. Imaging-guided, minimally invasive therapies are also emerging as alternatives to surgical biopsy for breast lesions. As imaging techniques improve, the role of imaging will continue to evolve with the goal remaining a decrease in breast cancer morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. American Cancer Society:Cancer facts and figures 2004. Accessible at http:/www.cancer.org. Accessed October 10, 2004.

  2. Kolb TM, Lichy J, Newhouse JH:Comparison of the performance of screening mammography, physical examination, and breast ultrasonography (US) and evaluation of factors that influence them:an analysis of 27,825 patient evaluations. Radiology 2002, 225:165–175. A large study from a single site that reconfirms the limitation on mammographic sensitivity imposed by high breast density and the increased detection rate of occult breast cancers on mammography that are provided by supplemental sonography.

    Article  PubMed  Google Scholar 

  3. Mandelson MT, Oestreicher N, Porter PL, et al.:Breast Density as a predictor of mammographic detection:comparison of interval- and screen-detected cancers. Natl Cancer Inst 2000, 92:1081–1087.

    Article  CAS  Google Scholar 

  4. Fracheboud J, Otto SJ, van Diijck JAAM, et al.:Decreased rates of advanced breast cancer due to mammography screening in The Netherlands. Br J Cancer 2004, 91:861–867.

    PubMed  CAS  Google Scholar 

  5. Ernst MF, Voogd AC, Coebergh JWW, Roukema JA:Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mammographic screening. Cancer 2004, 100:1337–1344.

    Article  PubMed  Google Scholar 

  6. Suryanarayanan S, Karellas A, Vedantham S, et al.:Flatpanel digital mammography system:contrast-detail comparison between screen-film radiographs and hard-copy images. Radiology 2002, 225:801–807.

    Article  PubMed  Google Scholar 

  7. Lewin JM, Hendrick RE, D’Orsi CJ, et al.:Comparison of full-field digital mammography with screen-film mammography for cancer detection:results of 4945 paired examinations. Radiology 2001, 218:873–880.

    PubMed  CAS  Google Scholar 

  8. Lewin JM, D’Orsi CJ, Hendrick RE, et al.:Clinical comparison of full-field digital mammography and screen-film mammography for detection of breast cancer. AJR Am J Roentgenol 2002, 179:671–677. An early study comparing detection and recall rates of screen film mammography and full field digital mammography showing no significant difference in cancer detection. The result of the ACRIN DMIST study comparing screen-film mammography to full field digital mammography will be reported in late 2005.

    PubMed  Google Scholar 

  9. Skaane P, Skjennald A:Screen-film mammography versus full-field digital mammography with soft-copy reading:randomized trial in a population-based screening program — the Oslo II study. Radiology 2004, 232:197–204.

    Article  PubMed  Google Scholar 

  10. Skaane P, Young K, Skjennald: Population-based mammography screening:comparison of screen-film and full-field digital mammography with soft-copy reading - Oslo I study. Radiology 2003, 229:887–884.

    Article  Google Scholar 

  11. Fischer U, Baum, F Obenauer, et al.:Comparative study in patients with microcalcifications:full-field digital mammography versus screen-film mammography. Eur Radiol 2002, 12:2679–2683.

    PubMed  CAS  Google Scholar 

  12. Diekmann S, Bick U, Von Heyden H, et al.:Visualization of microcalcifications on mammographies obtained by digital full-field mammography in comparison to conventional film-screen mammography. Rofo 2003, 175:775–779.

    PubMed  CAS  Google Scholar 

  13. Yamada T, Ishibashi T, Sato A, et al.:Comparison of screen-film and full-field digital mammography:image contrast and lesion characterization. Radiat Med 2003, 21:166–171.

    PubMed  Google Scholar 

  14. Obenhauer S, Luftner-Nagel S, von Heyden D, et al.:Screen film versus full-field digital mammography:image quality, detectability and characterization of lesions. Eur Radiol 2002, 12:1697–1702.

    Article  Google Scholar 

  15. Pisano ED:Current Status of full-field digital mammography. Radiology 2000, 214:26–28.

    PubMed  CAS  Google Scholar 

  16. Lewin JM, D’Orsi CJ, Hendrick RE:Digital mammography. Radiol Clin North Am 2004, 42:871–884.

    Article  PubMed  Google Scholar 

  17. Destounis SV, DiNitto P, Logan-Young W, et al.:Can computer-aided detection with double reading of screening mammograms help decrease the falsenegative rate? Initial experience. Radiology 2004, 232:578–584.

    Article  PubMed  Google Scholar 

  18. Brem RF, Baum J, Lechner M, et al.:Improvement in sensitivity of screening mammography with computer-aided detection:a multi-institutional trial. AJR Am J Roentgenol 2003, 181:687–693.

    PubMed  Google Scholar 

  19. Warren Burhenne LJ, Wood SA, D’Orsi CJ, et al.:Potential contribution of computer-aided detection to the sensitivity of screening mammography. Radiology 2000, 215:554–562.

    Google Scholar 

  20. Freer TW, Ulissey MJ:Screening mammography with computer-aided detection:prospective study of 12,860 patients in a community breast center. Radiology 2001, 220:781–786.

    Article  PubMed  CAS  Google Scholar 

  21. Birdwell RL, Ikeda DM, O’Shaughnessy KF, et al.:Mammographic characteristics of 115 missed cancers later detected with screening mammography and the potential utility of computer-aided detection. Radiology 2001, 219:192–202.

    PubMed  CAS  Google Scholar 

  22. Suryanarayahan S, Karellas A, Vedantham S, et al.:Comparison of tomosynthesis methods used with digital mammography. Acad Radiol 2000, 7:1085–1097.

    Article  Google Scholar 

  23. Stevens GM, Birdwell RL, Beaulieu CF, et al.:Circular tomosynthesis:potential in imaging of breast and upper cervical spine—preliminary phantom and in vitro study. Radiology 2003, 228:569–575.

    Article  PubMed  Google Scholar 

  24. Rafferty E:Tomosynthesis:new weapon in breast cancer fight. Accessible at http:/www.imagingeconomics. com. Accessed October 10, 2005.

  25. Buchberger W, Niehoff A, Obrist P, et al.:Clini1cally and mammographically occult breast lesions:detection and classification with high-resolution sonography. Semin Ultrasound CT MR 2000, 21:325–336.

    Article  PubMed  CAS  Google Scholar 

  26. Kaplan SS:Clinical utility of bilateral whole-breast US in the evaluation of women with dense-breast tissue. Radiology 2001, 221:641–649.

    Article  PubMed  CAS  Google Scholar 

  27. Crystal P, Strano SD, Shcharynski S, Koretz MJ:Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol 2003, 181:177–182.

    PubMed  Google Scholar 

  28. Leconte I, Feger C, Galant C, et al.:Mammography and subsequent whole-breast sonography of nonpalpable breast cancers:the importance of radiologic breast density. AJR Am J Roentgenol 2003, 180:1675–1679.

    PubMed  Google Scholar 

  29. Berg WA:Rationale for a trial of screening breast ultrasound:American College of Radiology imaging network (ACRIN) 6666. AJR Am J Roentgenol 2003, 180:1225–1228.

    PubMed  Google Scholar 

  30. Berg WA:Supplemental screening sonography in dense breasts. Radiol Clin North Am 2004, 42:845–851.

    Article  PubMed  Google Scholar 

  31. Morris EA, Liberman L, Ballon DJ, et al.:MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol 2003, 181:619–626.

    PubMed  Google Scholar 

  32. Warner E, Plewes DB, Shumak RS, et al.:Comparison of breast magnetic resonance imaging, mammography, and ultrasound for surveillance of women at high risk for hereditary breast cancer. J Clin Oncol 2001, 19:3524–3531.

    PubMed  CAS  Google Scholar 

  33. Warner E, Plewes DB, Hill KA, et al.:Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 2004, 292:1317–1325.

    Article  PubMed  CAS  Google Scholar 

  34. Liberman L:Breast cancer screening with MRI - what are the data for patients at high risk? N Engl J Med 2004, 351:497–500.

    Article  PubMed  CAS  Google Scholar 

  35. Kriege M, Brekelmans CTM, Boetes C, et al.:Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004, 351:427–437. An important study comparing the sensitivities of mammography and clinical breast examination to that of MRI in 1909 women with a genetic or familial predisposition to breast cancer and a cumulative lifetime risk of 15% or more. The sensitivity of MRI is 79.5% compared with 33.3% for mammography and 17.9% for clinical breast examination.

    Article  PubMed  CAS  Google Scholar 

  36. Stoutjesdijk MJ, Boetes C, Jager GJ, et al.:Magnetic resonance imaging and mammography in women with a hereditary risk of breast cancer. J Natl Cancer Inst 2001, 93:1095–1102.

    Article  PubMed  CAS  Google Scholar 

  37. Kuhl CK, Schmutzler RK, Leutner CC, et al.:Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene:preliminary results. Radiology 2000, 215:267–279.

    PubMed  CAS  Google Scholar 

  38. Tilanus-Linthorst MMA, Obdeijn IMM, Bartels KCM, et al.:First experiences in screening women at high risk for breast cancer with MR imaging. Breast Cancer Res Treat 2000, 65:53–60.

    Article  Google Scholar 

  39. Podo F, Sardanelli F, Canese R, et al.:The Italian multicenter project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk. J Exp Clin Cancer Res 2002, 21:115–124.

    PubMed  CAS  Google Scholar 

  40. Lee CH:Problem solving MR imaging of the breast. Radiol Clin North Am 2004, 42:919–934.

    Article  PubMed  Google Scholar 

  41. American College of Radiology:Standard for the performance of breast ultrasound examination. Paper presented at the Annual meeting of the American College of Radiology. Reston, VA, January 8, 2002.

  42. Mendelson EB:Problem-solving ultrasound. Radiol Clin North Am 2004, 42:909–918.

    Article  PubMed  Google Scholar 

  43. Soo MS, Rosen EL, Baker JA, et al.:Negative predictive value of sonography with mammography in patients with palpable breast lesions. AJR Am J Roentgenol 2001, 177:1167–1170.

    PubMed  CAS  Google Scholar 

  44. American College of Radiology:Appropriateness criteria ACR:imaging work-up of palpable breast masses. Paper presented at the American College of Radiology. Reston, VA, July 10–13, 2003.

  45. Moon WK, Noh D, Im J:Multifocal, multicentric, and contralateral breast cancers:bilateral whole-breast US in the preoperative evaluation of patients. Radiology 2002, 224:569–576.

    Article  PubMed  Google Scholar 

  46. Berg WA, Gilbreath PL:Multicentric and multifocal cancer:whole-breast US in preoperative evaluation. Radiology 2000, 214:59–66.

    PubMed  CAS  Google Scholar 

  47. American College of Radiology:ACR practice guideline for performance of magnetic resonance imaging (MRI) of the breast. Paper presented at Annual Meeting of the American College of Radiology. Reston, VA, March 19, 2004.

  48. Lee CH, Smith RC, Levine JA, et al.:Clinical usefulness of MR imaging of the breast in the evaluation of the problematic mammogram. AJR Am J Roentgenol 1999, 173:1323–1329.

    PubMed  CAS  Google Scholar 

  49. Balu-Maestro C, Chapellier, Bleuse A, et al.:Imaging in evaluation of response to neoadjuvant breast cancer treatment benefits of MRI. Breast Cancer Res Treat 2002, 72:145–152.

    Article  PubMed  CAS  Google Scholar 

  50. Orel SG, Schnall MD:MR imaging of the breast for the detection, diagnosis and staging of breast cancer. Radiology 2001, 201:13–30.

    Google Scholar 

  51. Partridge SC, Gibbs JE, Lu Y, et al.:Accuracy of MR imaging for revealing residual breast cancer in patients who have undergone neoadjuvant chemotherapy. AJR Am J Roentgenol 2002, 179:1193–1199.

    PubMed  Google Scholar 

  52. Weatherall PT, Evans GF, Metzger GJ, et al.:MRI versus histologic measurement of breast cancer following chemotherapy:comparison with X-ray mammography and palpation. J Magn Reson Imaging 2001, 13:868–875.

    Article  PubMed  CAS  Google Scholar 

  53. Rosen EL, Blackwell KL, Baker JA, et al.:Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol 2003, 181:1275–1282.

    PubMed  Google Scholar 

  54. Fischer U, Kopka L, Grabbe E:Breast carcinoma:effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 1999, 213:881–888.

    PubMed  CAS  Google Scholar 

  55. Hwang ES, Kinkel K, Esserman LJ, et al.:Magnetic resonance imaging in patients diagnosed with ductal carcinoma-in-situ:value in the diagnosis of residual disease, occult invasion, and multicentricity. Annals of Surgical Oncology 2003, 10:381–388.

    Article  PubMed  Google Scholar 

  56. Kneeshaw PJ, Turnbull LW, Smith A, Drew PJ:Dynamic contrast enhanced magnetic resonance imaging of the breast is superior to triple assessment for the preoperative detection of multifocal breast cancer. Eur J Surg Oncol 2003, 29:32–37.

    Article  PubMed  CAS  Google Scholar 

  57. Sardanelli F, Giuseppetti GM, Panizza P, et al.:Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol 2004, 183:1149–1157.

    PubMed  Google Scholar 

  58. Frei KA, Kinkel K, Bonal HM, et al.:MR imaging of the breast in patients with positive margins after lumpectomy. AJR Am J Roentgenol 2000, 175:1577–1584.

    PubMed  CAS  Google Scholar 

  59. Lee JM, Orel SG, Czerniecki BJ, et al.:MRI before reexcision surgery in patients with breast cancer. AJR Am J Roentgenol 2004, 182:473–480.

    PubMed  Google Scholar 

  60. Berg WA, Gutierrez L, NessAiver MS, et al.:Diagnostic accuracy of mammography, clinical examination, US and MR imaging in preoperative assessment of breast cancer. Radiology 2004, 233:830–849.

    Article  PubMed  Google Scholar 

  61. Schuster DM, Halkar RK:Molecular imaging in breast cancer. Radiol Clin North Am 2004, 42:885–908. An excellent status report on the current and future roles of molecular imaging in detection, management and treatment of breast cancer.

    Article  PubMed  Google Scholar 

  62. CMS Coverage Issues Manual Diagnostic Services. Accessible at http://cms.hhs.gov/manuals/06_cim/ ci50.asp#_50_36. Accessed October 10, 2004.

  63. Buscombe JR, Holloway B, Roche N, Bombardieri:Position of nuclear medicine modalities in the diagnostic work-up of breast cancer. Q J Nucl Med Mol Imaging 2004, 48:109–118.

    PubMed  CAS  Google Scholar 

  64. Crippa F, Gerali A, Alessi A, et al.:Fluoro-2-deoxy-Dglucose (FDG) positron-emission-tomography (PET) for axillary lymph node staging in primary breast cancer. Eur J Nucl Med Mol Imaging 2004, 31:97–102.

    Article  Google Scholar 

  65. Harisinghani MG, Dixon WT, Saksena MA, et al.:MR lymphangiography:imaging strategies to optimize the imaging of lymph nodes with Ferumoxtran-10. Radiographics 2004, 24:867–878.

    Article  PubMed  Google Scholar 

  66. Michel SCA, Keller TM, Frohlich JM, et al.:Preoperative breast cancer staging:MR imaging of the axilla with ultrasmall superparamagnetic iron oxide enhancement. Radiology 2002, 225:527–536.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reddy, D.H., Mendelson, E.B. Incorporating new imaging models in breast cancer management. Curr. Treat. Options in Oncol. 6, 135–145 (2005). https://doi.org/10.1007/s11864-005-0021-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-005-0021-2

Keywords

Navigation