Breast Imaging at RSNA: Focus on Integration

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Lisa Fratt, Editor

The operative word for the RSNA 2010 women’s imaging committee is integration. “RSNA has focused more on bringing together science and basic understanding in certain broad areas,” Robyn Birdwell, MD, director of breast imaging at Dana Farber Cancer Institute in Boston and chair of the RSNA breast imaging subcommittee, tells Health Imaging News.

The women’s imaging section has embraced Integrated Science and Practice (ISP) sessions and packed the schedule with sessions that allow participants to interact with moderators. The typical format starts with a refresher course followed by related abstracts, Birdwell notes.

At RSNA 2010, ISP sessions run the gamut, including breast tomosynthesis, digital mammography, automated ultrasound and emerging technologies. All are hot topics for 2010 and beyond. Mammography, in particular, has had an extremely tumultuous year.

Just over one year ago, the U.S. Preventive Services Task Force (USPSTF) shocked the women’s imaging community with recommendations that reduced screening mammography to a bi-annual visit for women between the ages of 50 and 74 and suggested women younger than age 50 and older than 74 forego mammography screening entirely. Breast imaging practices have been reeling with the ramifications ever since, resulting in reduced screening volumes. Some states and payors have even balked at continued coverage for screening studies. As a result, practices and professional organizations have employed a multi-pronged strategy to combat confusion among patients and physicians, relying on education, marketing and advocacy.

There have been partial victories such as the Department of Health and Human Services guidelines that recommend payors cover screening mammography beginning at age 40. However, a Norwegian study in September attributed minimal mortality reductions to screening—suggesting that increased awareness and improved treatments rather than mammograms are the main force in reducing the breast cancer death rate. While other studies have reported more positive results, ongoing scrutiny and questions continue to wreak havoc on the screening model.

At the same time, practices are turning to other breast imaging tools with many investing in breast MRI, based on use recommendations for dense-breasted women. “Breast MRI is not new, but it’s a very popular area,” continues Birdwell. “Researchers are starting to ask [and answer] different questions about risk factors.” For example, they are looking into phenotypes linked to different risk factors.

And new data are starting to indicate the value of breast MR as an adjunct screening tool for moderate- risk women, says Birdwell. Although these single-institution studies don’t substitute for randomized clinical trials, they may provide enough evidence to propel national organizations toward a screening recommendation for this challenging group.

Other technologies worth a look either in scientific sessions or on the show floor include molecular breast imaging, ultrasound elastography, digital tomosynthesis and computer-aided detection (look for computer-aided detection, too). 

Lisa Fratt
Editor of Health Imaging & IT