Breast Tumor Imaging

  • Deirdre Coll
Part of the Cancer Treatment and Research book series (CTAR, volume 143)

Breast cancer is the second leading cause of cancer death in women in the United States. This means that every year in the U.S., approximately 40,000 women die of this disease. Statistics from the United Kingdom show that approximately 13,000 women die of breast cancer each year. According to the World Health Organization, more than 1.2 million people will be diagnosed with breast cancer this year worldwide. The chance of developing invasive breast cancer during a woman’s lifetime is approximately 1 in 8 (about 13%).

The importance of developing new imaging tools for the detection and diagnosis of breast disease is therefore self-evident. There have been encouraging advances in the treatment of breast cancer including newer minimally invasive surgical techniques and more advanced oncology and radiation therapy options. Physicians and surgeons today require more sophisticated information before making treatment decisions for their patients. Imaging techniques have evolved in response to these demands. This chapter will attempt to summarize and explain the application of existing and new imaging technology in the diagnosis, treatment and management of breast cancer.


Breast Cancer Invasive Lobular Carcinoma Digital Mammography Digital Breast Tomosynthesis Extensive Intraductal Component 
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  1. 1.
    See e.g., JP Garne, K Aspegren, G Balldin, J Ranstam. Increasing incidence of and declining mortality frombreast carcinoma. Trends in Malmo, Sweden, 1961–1992. Cancer 1997; 79:69–74; KC Chu, RE Tarone, LG Kessler, et al. Recent trends in US breast cancer incidence, survival and mortality rates. Journal of the National Cancer Institute 1996; 88:1571–1579.CrossRefGoogle Scholar
  2. 2.
    AL Svendsen, AH Olsen, M von Euler-Chelpin, et al. Breast cancer incidence after the introduction of mammography screening: what should be expected? Cancer 2006; 106:1883–1890.PubMedCrossRefGoogle Scholar
  3. 3.
    Warwick, L Tabar, B Vitak, SW Duffy. Time-dependent effects on survival in breast carcinoma: Results from 20 years of follow-up from the Swedish two-county study. Cancer 2004; 100:1331–1336.PubMedCrossRefGoogle Scholar
  4. 4.
    See e.g., DB Kopans. 1992. The positive predictive value of mammography. Am. J. Roentgenology. 158:521_526; V Jackson, R Hendrick, S Feig, D Kopans. 1993. Imaging of the radiographically dense breast. Radiology. 188:297_301.Google Scholar
  5. 5.
    RD Rosenberg, et al. Performance Benchmarks for Screening Mammography. Radiology 2006; 241:55–66.PubMedCrossRefGoogle Scholar
  6. 6.
    See e.g., DD Dershaw, RC Fleischman, L Liberman, B Deutch, AF Abramson, and L Hann. Use of digital mammography in needle localization procedures. Am. J. Roentgenol., Sep 1993; 161: 559–562; A practical approach to minimally invasive breast biopsy. SH Parker, F Burbank - Radiology, 1996.Google Scholar
  7. 7.
    See e.g., James JJ. The current status of digital mammography. Clin Radiol 2004; 59:1–10; Guidance for the Submission of 510(k)’s for Solid State X-ray Imaging Devices, available at (last accessed 7/3/07).
  8. 8.
    JM Lewin, C J. D’Orsi, R. E Hendrick et al. Clinical Comparison of Full-Field Digital Mammography and Screen-Film Mammography for Detection of Breast Cancer. Am. J. Roentgenol. Sep 2002; 179: 671–677.Google Scholar
  9. 9.
    See e.g., Yip WM, Pang SY, Yim WS, Kwok CS. ROC analysis of lesion detectability on phantoms: comparison of digital spot film mammography with conventional spot film mammography. Br J Radiol 2001;74:621–628; Comparison of Calcification Specificity in Digital Mammography Using Soft-Copy Display Versus Screen-Film Mammography. Hak Hee Kim1, Etta D. Pisano2, Elodia B. Cole2, et al. AJR 2006; 187:47–50.PubMedGoogle Scholar
  10. 10.
    ED Pisano et al. Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening. 2005; NEJM 353: 1773–1783.PubMedCrossRefGoogle Scholar
  11. 11.
    Chang CHJ, Nesbit DE, Fisher DR, et al. Computed tomographic mammography using a conventional body scanner. Am J Roentgenol 1982;138:553–558.Google Scholar
  12. 12.
    Dromain C. Balleyguier C. Muller S, et al. Evaluation of tumor angiogenesis of breast carcinoma using contrast-enhanced digital mammography. AJR. American Journal of Roentgenology. 187(5):W528–37, 2006.PubMedCrossRefGoogle Scholar
  13. 13.
    Lewin JM, Isaacs PK, Vance V, et al. Dual-energy contrast-enhanced digital subtraction mammography: feasibility. Radiology 2003;229: 261–268.PubMedCrossRefGoogle Scholar
  14. 14.
    LT Niklason, et al. Digital Tomosynthesis in Breast Imaging. Radiology 1997; 205:399–406.PubMedGoogle Scholar
  15. 15.
    Rafferty E, Niklason L, Jameson-Meehan L. Breast Tomosynthesis: One view or Two. RSNA Scientific Paper 2006.Google Scholar
  16. 16.
    Rafferty EA. Tomosynthesis: New weapon in breast cancer fight. Decis Imaging Econ 2004: 17.Google Scholar
  17. 17.
    SC Chen et al. Initial Clinical Experience With Contrast-Enhanced Digital Breast Tomosynthesis. Acad Radiol 2007; 14:229–238.PubMedCrossRefGoogle Scholar
  18. 18.
    CHJ Chang, JL Sibala, JH Gallagher et al. 1977. Computed tomography of the breast: A preliminary report. Radiology 124:827_829.PubMedGoogle Scholar
  19. 19.
    Chang, CH, DE Nesbit, and DR Fisher, Computed tomographic mammography using a conventional body scanner. AJR Am J Roentgenol, 1982. 138: p. 553–558.PubMedGoogle Scholar
  20. 20.
    JM Boone, TR Nelson, KK Lindfors, JA Siebert. 2001. Dedicated breast CT: radiation dose and image quality evaluation. Radiology. 221:657_667.PubMedCrossRefGoogle Scholar
  21. 21.
    Boone JM Kwan AL, Seibert JA et al. Technique factors and their relationship to radiation dose in pendant geometry breast Med Phys. 32, 3767–3776 (2005).PubMedCrossRefGoogle Scholar
  22. 22.
    ACR Appropriateness Criteria for Breast Ultrasound.Google Scholar
  23. 23.
    Szopinski KT, Pajk AM, Wysocki M, et al: Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med 22:479–487, 2003.PubMedGoogle Scholar
  24. 24.
    Rosen EL, Soo MS: Tissue harmonic imaging sonography of breast lesions. Improved margin analysis, conspicuity, and image quality compared to conventional ultrasound. Clin Imaging 25:379–384, 2001.PubMedCrossRefGoogle Scholar
  25. 25.
    Powers JE, Burns PN, Souquet J. Imaging instrumentation for ultrasound contrast agents. In: Nanda NC, Schlief R, Goldberg BB, eds. Advances in echo imaging using contrast enhancement. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1997:139–170.Google Scholar
  26. 26.
    Jespersen SK, Wilhjelm JE, Sillesen H. Multiangle compound imaging. Ultrason Imaging1998; 20:81–102; Huber S, Wagner M, Medl M, et al.: Real time spatial compound imaging in breast ultrasound. Ultrasound Med Biol 28:155–163, 2002.PubMedGoogle Scholar
  27. 27.
    Sehgal CM, Arger PH, Rowling SE: Quantitative vascularity of breast masses by Doppler imaging: regional variations and diagnostic implications. J Ultrasound Med 19:427–440, 2000; Lee SW, Choi HY, Baek SY, et al.: Role of color and power Doppler imaging in differentiating between malignant and benign solid breast masses. J Clin Ultrasound 30:459–464, 2002.PubMedGoogle Scholar
  28. 28.
    Birdwell RL, Ikeda DM, Jeffrey SS, et al.: Preliminary experience with power Doppler imaging of solid breast masses. AJR Am J Roentgenol 169:703–707, 1997; Wilkens TH, Burke BJ, Cancelada DA, et al.: Evaluation of palpable breast masses with color Doppler sonography and gray scale imaging. J Ultrasound Med 17:109–115, 1998.PubMedGoogle Scholar
  29. 29.
    Chang RF, Huang SF, Moon WK, et al. Solid breast masses: neural network analysis of vascular features at three-dimensional power Doppler US for benign or malignant classification. Radiology. 2007; 243(1):56–62.PubMedCrossRefGoogle Scholar
  30. 30.
    Caumo F, Carbognin G, Casarin A, et al. Angiosonography in suspicious breast lesions with non-diagnostic FNAC: comparison with power Doppler US. Radiol Med (Torino). 2006; 111(1):61–72.CrossRefGoogle Scholar
  31. 31.
    J. Ophir, B. Garra and F. Kallel, et al., Elastographic imaging, Ultrasound Med Biol. 2000; 26: 23–29.CrossRefGoogle Scholar
  32. 32.
    S.F. Levinson, M. Shinagawat and T. Satot, Sonoelastic determination of human skeletal muscle elasticity, J Biomechanics 10 (1995), pp. 1145–1154. S Catheline, F Wu and M Fink. A solution to diffraction biases in sonoelasticity: the acoustic impulse technique, J Acoust Soc Am 105 (1999), pp. 2941–2950.CrossRefGoogle Scholar
  33. 33.
    Itoh A. Ueno E. Tohno E. Kamma H. Takahashi H. Shiina T. Yamakawa M. Matsumura T. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006; 239(2):341–50.PubMedCrossRefGoogle Scholar
  34. 34.
    A. Thomas, T. Fischer and H. Frey et al., An advanced method of ultrasound—real-time elastography: first results in 108 patients with breast lesions, Ultrasound Obst Gyn 28 (2006), pp. 335–340.CrossRefGoogle Scholar
  35. 35.
    Garra BS. Cespedes EI. Ophir J. Spratt SR. Zuurbier RA. Magnant CM. Pennanen MF. Elastography of breast lesions: initial clinical results. Radiology. 1997; 202(1):79–86.PubMedGoogle Scholar
  36. 36.
    See e.g., MJ Stoutjesdijk et al. Variability in the Description of Morphologic and Contrast Enhancement Characteristics of Breast Lesions on Magnetic Resonance Imaging. Invest Radiol 2005;40: 355–362; MD Schnall et al. Diagnostic Architectural and Dynamic Features at Breast MR Imaging: Multicenter Study. Radiology 2006; 238: 42–53.PubMedCrossRefGoogle Scholar
  37. 37.
    American College of Radiology (ACR). ACR BI-RADS®—Mammography, ACR Breast Imaging Reporting and Data System, Breast Imaging Atlas. Reston, VA, American College of Radiology, 2003.Google Scholar
  38. 38.
    Kuhl CK, Mielcareck P, Klaschik S, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 1999; 211:101–110.PubMedGoogle Scholar
  39. 39.
    MD Schnall et al. Diagnostic Architectural and Dynamic Features at Breast MR Imaging: Multicenter Study. Radiology 2006; 238: 42–53.PubMedCrossRefGoogle Scholar
  40. 40.
    Schnall MD, Ikeda DM. Lesion diagnosis working group report. J Magn Reson Imaging 1999; 10(6): 982–990.PubMedCrossRefGoogle Scholar
  41. 41.
    Christiane K. Kuhl, MD, Hans H. Schild, MD, Nuschin Morakkabati, MD. Dynamic Bilateral Contrast-enhanced MR Imaging of the Breast: Trade-off between Spatial and Temporal Resolution. Radiology 2005; 236:789–800.CrossRefGoogle Scholar
  42. 42.
    See e.g., Davis PL, McCarty KS: Sensitivity of enhanced MRI for the detection of breast cancer: new, multicentric, residual, and recurrent. Eur Radiol 7:S289–S298, 1997; Heywang-Köbrunner SH, Viehweg P, Heinig A, et al.: Contrast-enhanced MRI of the breast: accuracy, value, controversies, solutions. Eur J Radiol 24:94–108, 1997; Davis PL, Staiger MJ, Harris KB, et al.: Breast cancer measurements with magnetic resonance imaging, ultrasonography, and mammography. Breast Cancer Res Treat 37:1–9, 1996; and Yang WT, Lam WWM, Cheung H, et al.: Sonographic, magnetic resonance imaging and mammographic assessments of preoperative size of breast cancer. J Ultrasound Med 16:791–797, 1997.CrossRefGoogle Scholar
  43. 43.
    See e.g., Drew PJ, Chatterjee S, Turnbull LW, et al.: Dynamic contrast enhanced magnetic resonance imaging of the breast is superior to triple assessment for the pre-operative detection of multifocal breast cancer. Ann Surg Oncol 6:599–603, 1999; Esserman L, Hylton N, Yassa L, et al.: Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol 17:110–119, 1999.PubMedCrossRefGoogle Scholar
  44. 44.
    Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK. MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol 2003; 180:901–910.PubMedGoogle Scholar
  45. 45.
    Lehman CD, Gatsonis C, Kuhl CK et al; ACRIN Trial 6667 Investigators Group. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007 Mar 29;356(13):1295–303.PubMedCrossRefGoogle Scholar
  46. 46.
    Mandelson MT, Oestreicher N, Porter PL, et al. Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 2000; 92:1081–1087.PubMedCrossRefGoogle Scholar
  47. 47.
    Qayyum A, Birdwell RL, Daniel BL, et al. MR imaging features of infiltrating lobular carcinoma of the breast: histopathologic correlation. AJR Am J Roentgenol 2002;178:1227–1232.PubMedGoogle Scholar
  48. 48.
    Hilleren DJ, Andersson IT, Lindholm K, Linnell FS. Invasive lobular carcinoma: mammographic findings in a 10-year experience.Radiology 1991; 178:149–154.PubMedGoogle Scholar
  49. 49.
    See Hurd TC, Sneige N, Allen PK et al. Impact of extensive intraductal component on recurrence and survival in patients with stage I or II breast cancer treated with breast conservation therapy. Ann Surg Oncol 1997; 4: 119–124.[Abstract]; Schnitt SJ, Connolly JL, Harris JR et al. Pathologic predictors of early local recurrence in Stage I and II breast cancer treated by primary radiation therapy. Cancer 1984; 53: 1049–1057.PubMedCrossRefGoogle Scholar
  50. 50.
    Van Goethem M, Schelfout K, Kersschot E, et al. MR mammography is useful in the preoperative locoregional staging of breast carcinomas with extensive intraductal component. Eur J Radiol. 2007 Jan 11; Sundararajan S, Tohno E, Kamma H, Ueno E, Minami M.Role of ultrasonography and MRI in the detection of wide intraductal component of invasive breast cancer – a prospective study. Clin Radiol. 2007 Mar;62(3):252–61.PubMedCrossRefGoogle Scholar
  51. 51.
    Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of the breast cancer. Radiology 2001;220:13–30.PubMedGoogle Scholar
  52. 52.
    Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of the breast cancer. Radiology 2001;220:13–30.PubMedGoogle Scholar
  53. 53.
    Technology Evaluation Center (TEC). Breast MRI for detection or diagnosis of primary or recurrent breast cancer. Assessment Program 2004;vol19(No.1).Google Scholar
  54. 54.
    Role of MRI in screening women at high risk for breast cancer. J Magn Reson Imaging. 2006 Nov;24(5):964–70.Google Scholar
  55. 55.
    D Saslow et al. American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography. CA Cancer J Clin 2007; 57:75–89.PubMedCrossRefGoogle Scholar
  56. 56.
    Negendank W. Studies of human tumors by MRS: a review. NMR Biomed 1992;5:303–324.PubMedGoogle Scholar
  57. 57.
    Yeung DK, Cheung HS, Tse GM. Human breast lesions: characterization with contrast- enhanced in vivo proton MR spectroscopy— initial results. Radiology 2001;220: 40–46; Kvistad KA, Bakken IJ, Gribbestad IS, et al. Characterization of neoplastic and normal human breast tissues with in vivo (1) H MR spectroscopy. J Magn Reson Imaging 1999;10:159–164.PubMedGoogle Scholar
  58. 58.
    Jagannathan NR, Kumar M, Seenu, et al. Evaluation of total choline from in-vivo volume localized proton MR spectroscopy and its response to neoadjuvant chemotherapy in locally advanced breast cancer.Br J Cancer. 2001 Apr 20;84(8):1016–22.PubMedCrossRefGoogle Scholar
  59. 59.
    Gambhir SS: Molecular imaging of cancer with positron emission tomography. Nat Rev Cancer 2:684–693, 2002.CrossRefGoogle Scholar
  60. 60.
    Centers for Medicare and Medicaid Services. National Coverage Analysis (NCA), Positron Emission Tomography (FDG) for Breast Cancer (#CAG-00094N).Google Scholar
  61. 61.
    Wahl RL. Current status of PET in breast cancer imaging, staging, and therapy.Semin Roentgenol 2001;36:250–60.PubMedCrossRefGoogle Scholar
  62. 62.
    Buck A, Schirrmeister H, Kuhn T, et al. FDG uptake in breast cancer: correlation with biological and clinical prognostic parameters. Eur J Nucl Med Mol Imaging 2002; 29:1317–1323.PubMedCrossRefGoogle Scholar
  63. 63.
    Avril N, Rose CA, Schelling M, et al. Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations. J Clin Oncol 2000; 18: 3495–3502.PubMedGoogle Scholar
  64. 64.
    A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases. Carmen R. Isasi, Renee M. Moadel, and M. Donald Blaufox. Breast Cancer Research and Treatment (2005) 90: 105–112.PubMedCrossRefGoogle Scholar
  65. 65.
    Dose J, Bleckmann C, Bachmann S, et al. Comparison of fluorodeoxyglucose positron emission tomography and “conventional diagnostic procedures” for the detection of distant metastases in breast cancer patients. Nucl Med Commun 2002;23:857–864.PubMedCrossRefGoogle Scholar
  66. 66.
    Lonneux M, Borbath I, Berliere M, et al. The place of whole-body FDG PET for the diagnosis of distant recurrence of breast cancer. Clinical Positron Imaging 2000;3:45–49.PubMedCrossRefGoogle Scholar
  67. 67.
    Schelling M, Avril N, Nahrig et al. Positron emission tomography using [18F]fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer. J Clin Oncol 2000; 18:1689–1695.PubMedGoogle Scholar
  68. 68.
    Biersack HJ, Palmedo H. Locally advanced breast cancer: Is PET useful for monitoring primary chemotherapy? J Nucl Med 2003; 44:1815–1817.PubMedGoogle Scholar
  69. 69.
    Adler LP, Weinberg IN, Bradbury MS et al. The Breast Journal, Volume 9, Number 3, 2003 163–166.PubMedCrossRefGoogle Scholar
  70. 70.
    Leonard Berlin, Malpractice Issues in Radiology: Possessing Ordinary Knowledge, 166 AJR 1027 (1996).PubMedGoogle Scholar
  71. 71.
    Leonard Berlin, Malpractice Issues in Radiology: Errors in Judgment, 166 AJR 1259 (1996).PubMedGoogle Scholar
  72. 72.
    Leonard Berlin, Malpractice Issues in Radiology: Perceptual Errors, 167 AJR 587, 589 (1997).Google Scholar
  73. 73.
    Leonard Berlin, Malpractice Issues in Radiology: Picture Archiving and Communications Systems (PACS) and the Loss of Patient Examination Records, 176 AJR 1381 (2001).PubMedGoogle Scholar
  74. 74.
    BJ Erickson & B Bartholmai, Computer-Aided Detection and Diagnosis at the Start of the Third Millennium, 15(2) Journal of Digital Imaging 59 (2002).PubMedCrossRefGoogle Scholar
  75. 75.
    RS Rana, et al., Independent Evaluation of Computer Classification of Malignant and Benign Calcifications in Full-Field Digital Mammograms. 14 Acad Radiol 363 (2007).PubMedCrossRefGoogle Scholar
  76. 76.
    EA Krupinski. Computer-aided Detection in Clinical Environment: Benefits and Challenges for Radiologists. 231 Radiology 7 (2004).PubMedCrossRefGoogle Scholar
  77. 77.
    Such psychological effects could be measured by conducting studies where radiologists interpret the same mammograms using the same CADe device at three separate reading sessions separated in time. The radiologists could be told that they are testing three separate CADe devices: one CADe device designed to detect BI-RADS 3 or higher potential abnormalities; a second CADe device designed to only detect BI-RADS 5 potential abnormalities; and a third CADe device designed to only detect actual malignancies. At each reading session, the radiologists would interpret 1/3 of the mammograms with “each CADe device.” By having three reading sessions separated in time to avoid recall bias, each radiologist would ultimately interpret each mammogram with the same CADe device but with a different instruction as to the design of the CADe device.Google Scholar
  78. 78.
    EA Krupinski, et al., A Perceptually Based Method for Enhancing Pulmonary Nodule Recognition. 28(4) Investigative Radiology 289 (1993).PubMedCrossRefGoogle Scholar
  79. 79.
    See e.g., RL Birdwell et al., Mammographic Characteristics of 115 Missed Cancers Later Detected with Screening Mammography and the Potential Utility of Computer-aided Detection. 219 Radiology 192 (2001); LJW Burhenne, Potential Contribution of Computer-aided Detection to the Sensitivity of Screening Mammography. 215 Radiology 554 (2000); RF Brem et al., Improvement in Sensitivity of Screening Mammography with Computer-Aided Detection: A Multiinstitutional Trial. 181 AJR 687 (2003).PubMedGoogle Scholar
  80. 80.
    LJW Burhenne, Potential Contribution of Computer-aided Detection to the Sensitivity of Screening Mammography. 215 Radiology 554 (2000).Google Scholar
  81. 81.
    See RM Nishikawa and M Kallergi. Point/Counterpoint: Computer-aided Detection, in its Present Form, is not an Effective Aid for Screening Mammography. 33 Med Phys 811 (2006).PubMedCrossRefGoogle Scholar
  82. 82.
    JJ Fenton, et al., Influence of Computer-Aided Detection on Performance of Screening Mammography. 356 NEJM 1399 (2007).PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Deirdre Coll
    • 1
  1. 1.Department of RadiologyUniversity of Maryland Medical CenterUSA

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