Breast imaging used to be defined by mammography. But the field has undergone a technological revolution, with must-have modalities emerging from every direction.
“It's an exciting time,” said Dr. Ellen Mendelson, chief of breast and women's imaging at the Lynn Sage Comprehensive Cancer Center, Northwestern Memorial Hospital, in Chicago. “We are seeing real interest from our residents. The fellowship program has become very competitive.”
In the screening setting, the switch from film-based mammography to digital imaging has accelerated over the past five years. A far higher proportion of centers are now using full-field digital mammography. Studies suggest that FFDM may improve cancer detection rates in women with dense breasts while yielding diagnostic accuracy comparable to screen-film mammography for the wider population.1 Breast MRI is another technology that is gathering the “must have” tag, thanks to studies demonstrating its high sensitivity and value in selected patient populations.2-4 Targeted screening for women at high risk for breast cancer now increasingly includes an MR scan. Diagnostic workup and biopsy guidance that would previously have been done using ultrasound may now be directed to MRI. The modality's role as a staging tool is also growing.
“Whole-body MR is very competitive with, and a potential alternative to, whole-body PET for staging. It uses no ionizing radiation. We detect bone and liver lesions that are not seen on PET/CT, particularly with diffusion-weighted imaging, and we can visualize smaller lymph nodes as well,” said Dr. Bruce Porter, medical director of Swedish-First Hill Diagnostic Imaging in Seattle. “This has the potential to change how people look at their current staging protocols.”
OLD TECH, NEW TWIST
Breast radiologists are being offered a raft of new and improved imaging tools. Familiar modalities are being reinvented and alternative imaging techniques proposed, leaving practitioners with a dizzying choice of diagnostic options.
Digital x-ray tomosynthesis is one such technology that is creating some buzz. Tomosynthesis acquires multiple 2D projection images while the x-ray tube moves over a limited angular range around the compressed breast. The x-ray dose for each separate acquisition is low, minimizing the overall radiation burden to the patient. Thin slices, typically 1 mm in thickness, can be reconstructed from the projection images. The slices can be viewed one at a time or in a cine loop.
