Breast cancer accounts for almost a quarter of new cancer cases among women
Breast cancer remains a worldwide public health dilemma and is currently the most common tumor across the globe. Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact on the recognition and screening of breast cancer (1). About one in twenty females will be diagnosed with breast cancer over the course of their lifetime (2). In 2020, there were 2.3 million women diagnosed with breast cancer and 685 000 deaths globally(3). Currently, approximately 90% of women with breast cancer survive 5 years or more after diagnosis (4).
The breast cancer pathway (5)
The incidence of breast cancer in developed countries continues to rise; however, the rate of mortality has undergone a substantial decline. This is attributable to both improved methods of treatment, implementation of screening programs and improved imaging techniques. Critically, early detection ensures the best outcome for the patient, with survival grossly determined by the stage of the disease at the time of initial diagnosis. In this era of a rising incidence of breast cancer, ensuring diagnosis at the earliest possible stage requires further improvement in the capabilities of current diagnostic modalities and the development of novel imaging systems. Three modalities are currently used in the clinical routine for breast imaging diagnosis:
- Mammography and digital breast tomosynthesis exploit the attenuation of x-rays as they pass through breast tissue measured by the attenuation coefficient of the tissue;
- Magnetic resonance imaging uses radio waves, magnetic field gradients, and contrast agents to excite and measure the location of hydrogen atoms;
- Ultrasound exploits differences in acoustic impedance between tissue types as sound waves propagate in the breast.
Mammography is the gold standard imaging technique for screening, follow-up or in case of clinical signs (6).
However, in certain cases, mammography has limited sensitivity as for the study of high-density breasts (7) which requires additional examinations such as ultrasound (8) and/or MRI (9).
In recent years, new techniques less costly and more accessible than MRI, including Contrast-enhanced Mammography (CEM) have been developed (10). This technique improves both sensitivity and sensibility of breast cancer detection as it provides higher contrast and better lesion delineation than mammography alone (11,12).
Example of good agreement between tumor diameter measurement between CEM and breast MRI (13)
Images courtesy of dr. M. Lobbes, MD, PhD; Zuyderland Medical Center and Maastricht University Medical Center, the Netherlands.
Image example of good agreement between tumor diameter measurements using CESM and breast MRI. The cancer is ill-defined on the low-energy CESM image (A) and can be measured more confidently on the recombined image (B, 60 mm). Subtracted contrast-enhanced T1w images (C) showed a similar irregular mass (63 mm). Final pathological results showed a 60 mm invasive ductal carcinoma.
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Contrast-enhanced Mammography: State of the Art | Radiology (rsna.org), Maxine S. Jochelson, MD, Marc B. I. Lobbes, MD, PhD
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Sources and references
- Akram et al. Awareness and current knowledge of breast cancer Biol Res (2017) 50:33
- Breast Cancer | The Cancer Atlas
- Breast cancer (who.int)
- Breast Cancer Survival Rate: Prognosis by Age and More (healthline.com)
- Moloney Brian M. et al Breast Cancer Detection – A Synopsis of Conventional Modalities and the Potential Role of Microwave Imaging - Diagnostics 2020, 10, 103; doi:10.3390/diagnostics10020103 www.mdpi
- Sardanelli, Eva M. Fallenberg et al. Mammography: an update of the EUSOBI recommendations on information for women Francesco Insights Imaging (2017) 8:11–18
- Emaus MJ, Bakker MF, Peeters PH et al (2015) MR Imaging as an additional screening modality for the detection of breast cancer in women aged 50-75 years with extremely dense breasts: the DENSE trial study design. Radiology 0:141827
- Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 225:165–175
- Liberman L, Morris EA, Kim CM et al (2003) MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol 180:333–341
- M. Fallenberg et al. (2014). Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol (2014) 24:256–264
- Dromain C, Thibault F, Muller S et al (2011) Dual-energy contrast enhanced digital mammography: initial clinical results. Eur Radiol 21:565–574
- Dromain C, Thibault F, Diekmann F et al (2012) Dual-energy contrast- enhanced digital mammography: initial clinical results of a multireader, multicase study. Breast Cancer Res 14:R94 21:565–574 25.
- Marc B.I. Lobbes et al. The Quality of Tumor Size Assessment by Contrast Enhanced Spectral Mammography and the Benefit of Additional Breast MRI. Journal of Cancer 2015, Vol. 6 144 -150
P21000913 – September 2021