Breast imaging in the new era

Abstract

In the last decade,there have been huge advances in the field of breast imaging.Full field digital mammography systems optimise lesion to background contrast with resultant improvement in the sensitivity of the technique for cancer detection, facilitated by computer-aided detection.Though mammography remains the only established modality for population-based screening, preliminary results from several large studies indicate that magnetic resonance imaging(MRI) has a role in high-risk patients.On the other hand, advances in ultrasound, MRI and nuclear medicine have the potential to greatly improve the specificity of breast imaging with regard to cancer detection and lesion characterisation.A number of new and experimental techniques are being developed which may have great impact in this area and these will be discussed. Though MRI now has an established place in the diagnosis of breast cancer, it is becoming clear that it can directly affect surgical and medical management by enabling assessment of response to chemotherapy and endocrine therapy, and facilitating choice of the most appropriate surgery.Just as the role of MRI has evolved,so too the place of nuclear medicine, particularly positron emission tomography and radio-immunoscintigraphy should become clearer in the next few years.

Figure 1

Conventional film–screen (a) and digital (b) mammograms of the same patient, taken on the same day. Note much improved contrast detail within the glandular parenchyma with simultaneous visualisation of the skin on the digital image.

Figure 2

Sequential ultrasonographic images with power Doppler interrogation depicting the arrival of a bolus of microbubble contrast agent at a malignant tumour (figure courtesy of Dr E Moskovic, Royal Marsden Hospital). Note typical malignant tumour vascularisation.

Figure 3

(a, b) Staging MRI scans from a patient with suspected multifocal breast cancer. There is a type III time-intensity curve typical of malignancy (a). Note the presence of satellite nodules adjacent to the main tumour mass, well shown on the MIP image (b).

Figure 4

3D T1W gradient-echo MRI scan, with fat suppression, from a patient with a screen-detected cancer which was missed at excision. This post-contrast sagittal image clearly demonstrates an irregular enhancing malignant mass some distance from the linear enhancement seen in the surgical scar.

Figure 5

Tc99m hHMFG-1 radioimmunoscintigraphy. Positive right axillary nodes and breast cancer (figure courtesy of Professor K E Britton, St Bartholomew’s Hospital; reproduced by permission from: Br J Cancer 2002; 86: 870–8).