Exploring the Evolution of Breast Cancer Imaging: A Review of Conventional and Emerging Modalities

Abstract

Breast cancer (BC) is one of the leading causes of malignancy among women, and its prevalence is exponentially rising globally. Early and accurate imaging is critical for early detection, diagnosis, and treatment planning. This comprehensive review explores the current status of BC imaging, from the conventional methods such as mammography, ultrasound (US) and magnetic resonance imaging (MRI) to more advanced techniques including contrast-enhanced imaging, tomosynthesis, and molecular breast imaging (MBI). Conventional imaging remains the foundation for screening, as mammography is the most widely preferred modality. US and MRI are usually employed in dense breasts in highly suspicious cases that are not detected on a mammogram. However, the limitations posed by these traditional techniques can be curtailed using advanced modalities to enhance diagnostic accuracy. These emerging techniques provide faster and earlier detection of malignancy, particularly in high-risk patients, and substantially reduce the burden of missed cases. Emerging technologies, including photoacoustic imaging (PAI) and contrast-enhanced ultrasound (CEUS), show promising potential in visualizing microvascular structures and enhancing diagnostic accuracy. Additionally, artificial intelligence (AI) is revolutionizing BC imaging across all modalities by optimizing interpretation, enhancing sensitivity, and enabling personalized risk assessment. Although technological innovation continues to improve imaging quality and diagnostic precision, challenges such as cost, accessibility, overdiagnosis, and disparities in care remain a concern. Moving forward, a collaborative multimodal strategy that incorporates personalized imaging protocols and equitable access will be crucial for improving BC screening and management. The future of breast imaging lies not in replacing existing modalities but in developing a system where each technology complements the other, leading to earlier detection, more effective treatment, and enhanced outcomes.

Keywords: breast cancer; breast ultrasound; contrast-enhanced mammogram; contrast-enhanced ultrasound (ceus); magnetic resonance imaging breast; mammography; molecular breast imaging; photoacoustic imaging; positron emission tomography computed tomography.

Figure 1. Overview of role of radiological imaging in screening and detection of breast cancer

BI-RADS: Breast imaging-reporting and data system The figure has been made by Humza Siddiqui using biorender.com