Skip to main content

Value-Based Radiology in Breast Imaging

  • Chapter
  • First Online:
  • 490 Accesses

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

In this chapter, five common case presentations of everyday situations in the field of Breast Imaging are discussed.

We reinforce the importance of following best practice diagnostic guidelines in common issues, such as breast implant complications, assessment of nipple discharge, and the evaluation of the male symptomatic breast. Indeed, these guidelines are not always followed consistently in clinical practice which, in turn, has a direct negative effect on medical resource allocation decisions, contributing to expensive and ineffective procedures, with no additional benefit on healthcare outcomes.

We also highlight the role of MRI in the diagnosis and management of breast cancer. This technique combines excellent soft tissue contrast and detailed tumor angiogenesis information which contributes to its success in early cancer detection and in the assessment of treatment response after chemotherapy. Recently, it has also become clear that MRI is superior to mammography on ductal carcinoma in situ diagnosis (discussed in the last case scenario).

Finally, we hope that this overview is a useful tool not only for radiologists, including those not familiar with breast imaging, but also for the other members of the multidisciplinary teams composing breast units as well as general practitioners and other physicians that commonly refer symptomatic patients and seek a specialist opinion.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • American College of Radiology (2018) ACR practice parameter for the performance of contrast-enhanced magnetic resonance imaging (MRI) of the breast (Resolution 34). Revised 2018. Accessed 25 Sept 2018

    Google Scholar 

  • Appelbaum AH, Evans GF, Levy KR, Amirkhan RH, Schumpert TD (1999) Mammographic appearances of male breast disease. Radiographics 19(3):559–568

    Article  CAS  Google Scholar 

  • Baltzer P et al (2018) Is breast MRI a helpful additional diagnostic test in suspicious mammographic microcalcifications? Magn Reson Imaging 46:70–74

    Article  Google Scholar 

  • Berger N, Luparia A, Di Leo G, Carbonaro LA, Trimboli RM, Ambrogi F, Sardanelli F (2017) Diagnostic performance of MRI versus galactography in women with pathologic nipple discharge: a systematic review and meta-analysis. AJR Am J Roentgenol 209(2):465–471

    Article  Google Scholar 

  • Chesebro AL, Rives AF, Shaffer K (2018) Male breast disease: what the radiologist needs to know. Curr Probl Diagn Radiol (in press), accepted manuscript. Available online 29 Jul. pii: S0363-0188(18)30061-6

    Google Scholar 

  • Cohen E, Leung JWT (2018) Problem-solving MR imaging for equivocal imaging findings and indeterminate clinical symptoms of the breast. Magn Reson Imaging Clin N Am 26(2):221–233

    Article  Google Scholar 

  • De Boer M, van Leeuwen FE, Hauptmann M, Overbeek LIH, de Boer JP, Hijmering NJ, de Jong D (2018) Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol 4(3):335–341

    Article  Google Scholar 

  • Desforges JF, Braunstein GD (1993) Gynecomastia. New Engl J Med 328:490–495

    Article  Google Scholar 

  • Elshof EL et al (2015) Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ—the LORD study. Eur J Cancer 51:1497–1510

    Article  Google Scholar 

  • Evans A, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PA, Bick U, Camps Herrero J, Clauser P, Colin C, Cornford E, Fallenberg EM, Fuchsjaeger MH, Gilbert FJ, Helbich TH, Kinkel K, Heywang-Köbrunner SH, Kuhl CK, Mann RM, Martincich L, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Zackrisson S, Forrai G, Sardanelli F, European Society of Breast Imaging (EUSOBI), with language review by Europa Donna—The European Breast Cancer Coalition (2018) Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 9(4):449–461

    Article  Google Scholar 

  • Fowler AM, Mankoff DA, Bonnie NJ (2017) Imaging neoadjuvant therapy response in breast cancer. Radiology 285(2):358–375

    Article  Google Scholar 

  • Francis A et al (2015) LORIS trial: addressing overtreatment of ductal carcinoma in situ. Clin Oncol 27:6–8

    Article  CAS  Google Scholar 

  • Green LA, Karow JA, Toman JE, Lostumbo A, Xie K (2018) Review of breast augmentation and reconstruction for the radiologist with emphasis on MRI. Clin Imaging 47:101–117

    Article  Google Scholar 

  • Groen EJ et al (2017) Finding the balance between over- and under-treatment of ductal carcinoma in situ (DCIS). Breast 31:274–283

    Article  Google Scholar 

  • Hillard C, Fowler JD, Barta R, Cunningham B (2017) Silicone breast implant rupture: a review. Gland Surg 6(2):163–168

    Article  Google Scholar 

  • Huang XC et al (2018) A comparison of diagnostic performance of vacuum-assisted biopsy and core needle biopsy for breast microcalcification: a systematic review and meta-analysis. Ir J Med Sci 187(4):999–1008

    Article  Google Scholar 

  • Iuanow E, Kettler M, Slanetz PJ (2011) Spectrum of disease in the male breast. AJR Am J Roentgenol 196(3):247–259

    Article  Google Scholar 

  • Juanpere S, Perez E, Huc O, Motos N, Pont J, Pedraza S (2011) Imaging of breast implants—a pictorial review. Insights Imaging 2(6):653–670

    Article  Google Scholar 

  • Kuerer HM et al (2018) A clinical feasibility trial for identification of exceptional responders in whom breast cancer surgery can be eliminated following neoadjuvant systemic therapy. Ann Surg 267:946–951

    Article  Google Scholar 

  • Kuhl C, Strobel K, Bleling K, Wardelmann E, Walther K, Nikolaus M, Schrading S (2017) Impact of preoperative breast MR imaging and MR-guided surgery on diagnosis and surgical outcome of women with invasive breast cancer with and without DCIS component. Radiology 284(3):645–655

    Article  Google Scholar 

  • Lee SJ, Trikha S, Moy L, Baron P, diFlorio RM, Green ED, Heller SL, Holbrook AI, Lewin AA, Lourenco AP, Niell BL, Slanetz PJ, Stuckey AR, Vincoff NS, Weinstein SP, Yepes MM, Newell MS, Expert Panel on Breast Imaging (2017) ACR appropriateness criteria® evaluation of nipple discharge. J Am Coll Radiol 14(5S):S138–S153

    Article  Google Scholar 

  • Li GZ, Wong SM, Lester S, Nakhlis F (2018) Evaluating the risk of underlying malignancy in patients with pathologic nipple discharge. Breast J 24(4):624–627

    Article  Google Scholar 

  • Lippa N, Hurtevent-Labrot G, Ferron S, Boisserie-Lacroix M (2015) Nipple discharge: the role of imaging. Diagn Interv Imaging 96(10):1017–1032

    Article  CAS  Google Scholar 

  • Lourenco AP, Moy L, Baron P, Didwania AD, diFlorio RM, Heller SL, Holbrook AI, Lewin AA, Mehta TS, Niell BL, Slanetz PJ, Stuckey AR, Tuscano DS, Vincoff NS, Weinstein SP, Newell MS, Expert Panel on Breast Imaging (2018) ACR appropriateness criteria® breast implant evaluation. J Am Coll Radiol 15(5S):13–25

    Article  Google Scholar 

  • McGuire KP et al (2011) MRI staging after neoadjuvant chemotherapy for breast cancer: does tumor biology affect accuracy. Ann Surg Oncol 18:3149–3154

    Article  Google Scholar 

  • Mukhtar RA et al (2013) Clinically meaningful tumor reduction rates vary by prechemotherapy MRI phenotype and tumor subtype in the I-SPY 1 TRIAL (CALGB 150007/150012; ACRIN 6657). Ann Surg Oncol 20:3823–3830

    Article  Google Scholar 

  • National Comprehensive Cancer Network (2018) Breast cancer (Version 1.2018). http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 16 May 2018

  • Nguyen C, Kettler MD, Swirsky ME, Miller VI, Scott C, Krause R, Hadro JA (2013) Male breast disease: pictorial review with radiologic-pathologic correlation. Radiographics 33:763–779

    Article  Google Scholar 

  • Niell BL, Lourenco AP, Moy L, Baron P, Didwania AD, diFlorio-Alexander RM, Heller SL, Holbrook AI, Le-Petross HT, Lewin AA, Mehta TS, Slanetz PJ, Stuckey AR, Tuscano DS, Ulaner GA, Vincoff NS, Weinstein SP, Newell MS (2018) ACR appropriateness criteria evaluation of the symptomatic male breast. J Am Coll Radiol 15:313–320

    Article  Google Scholar 

  • Panzironi G, Pediconi F, Sardanelli F (2019) Nipple discharge: the state of the art. BJR Open 1(1):20180016

    Google Scholar 

  • Patel BK, Ferraro C, Kosiorek HE, Loving VA, D’Orsi C, Newell M, Gray RJ (2018) Nipple discharge: imaging variability among U.S. radiologists. AJR Am J Roentgenol 211(4):920–925

    Article  Google Scholar 

  • Paula IB, Campos AM (2017) Breast imaging in patients with nipple discharge. Radiol Bras 50(6):383–388

    Article  Google Scholar 

  • Scaranelo AM, Marques AF, Smialowski EB, Lederman HM (2004) Evaluation of the rupture of silicone breast implants by mammography, ultrasonography and magnetic resonance imaging in asymptomatic patients: correlation with surgical findings. Sao Paulo Med J 122(2):41–47

    Article  Google Scholar 

  • Scheel JR et al (2018) MRI, clinical examination, and mammography for preoperative assessment of residual disease and pathologic complete response after neoadjuvant chemotherapy for breast cancer: ACRIN 6657 trial. AJR 210(6):1376–1385

    Article  Google Scholar 

  • Seiler SJ, Sharma PB, Hayes JC, Ganti R, Mootz AR, Eads ED, Teotia SS, Evans WP (2017) Multimodality imaging-based evaluation of single-lumen silicone breast implants for rupture. Radiographics 37(2):366–382

    Article  Google Scholar 

  • Shin K, Martaindale S, Whitman GJ (2018) Male breast magnetic resonance imaging: when is it helpful? Our experience over the last decade. Curr Probl Diagn Radiol (in press), accepted manuscript. Available online 10 Jan. pii: S0363-0188(17)30307-9

    Google Scholar 

  • Thiruchelvam P, Walker JN, Rose K, Lewis J, Al-Mufti R (2016) Gynaecomastia. BMJ 354:i4833

    Article  Google Scholar 

  • Yang N, Muradali D (2011) The augmented breast: a pictorial review of the abnormal and unusual. Am J Roentgenol 196(4):451–460

    Article  Google Scholar 

  • Youn I et al (2015) Ultrasonography-guided surgical clip placement for tumor localization in patients undergoing neoadjuvant chemotherapy. J Breast Cancer 8(1):44–49

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Inês Leite .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Leite, I., Abreu, E.M. (2019). Value-Based Radiology in Breast Imaging. In: Silva, C., von Stackelberg, O., Kauczor, HU. (eds) Value-based Radiology. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2019_213

Download citation

  • DOI: https://doi.org/10.1007/174_2019_213

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-31554-2

  • Online ISBN: 978-3-030-31555-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics