Mammography, Magnetic Resonance Imaging of the Breast, and Radionuclide Imaging of the Breast

Abstract

Breast imaging plays an important role in screening for breast cancer, classifying and sampling nonpalpable breast abnormalities, and defining the extent of breast tumors. Randomized clinical trials and meta-analyses have demonstrated decreased mortality rates in women who undergo mammographic screening compared with unscreened controls. In the past decade, there have been notable improvements in mammographic image quality and positioning. In breast conservation therapy, mammography is used to define the extent of malignancy before definitive segmentectomy and to monitor the breast after surgery and radiation therapy. Percutaneous biopsy techniques have been developed to facilitate safe, accurate tissue acquisition. The use of stereotactic and ultrasound-guided biopsies has resulted in a decrease in the number of surgical biopsies performed. Mammography can also be used to guide needle localizations, most of which, in our practice, are performed to help guide the excision of known cancers. Whereas technetium Tc 99m sestamibi imaging has been reasonably accurate in the evaluation of palpable lesions, sestamibi imaging is thought to be limited in the evaluation of nonpalpable lesions. Magnetic resonance imaging shows promise for detecting breast cancers and defining the extent of disease. Magnetic resonance imaging—guided needle localization and core needle biopsy techniques are being developed, and these techniques should allow for the increased utilization of magnetic resonance imaging in the staging of breast cancers. Digital imaging systems offer opportunities for post-processing and reconfiguring of the original data. Digital mammography should result in improved image quality, a lower call-back rate, and, perhaps, a decreased radiation dose.