Breast imaging gaining ground

Mammography has long been a technique in need of improvement—and help is here.

As you'll see in this month's Special Focus on Breast Imaging, digital mammography is making a difference in its added ability over screen-film mammography to acquire images digitally, with faster acquisition times and shorter overall exams as well as manipulate images, more smoothly integrate CAD, and transmit images to other physicians. Though the clinical evidence is yet insufficient to determine whether digital mammography is superior based on factors such as contrast between dense and non-dense breast tissue, recall and biopsy rates, and radiation dose, the results of the Digital Mammographic Imaging Screening Trial (DMIST) are expected next spring. The results of the comparison of digital and film mammography in nearly 50,000 women conducted at 35 clinical sites in the U.S. and Canada will likely mean widespread reimbursement, or not. But as you'll see in the story beginning on page 26, digital mammography is key to success in a variety of sites already.

Breast ultrasound (page 36) also is fortifying breast cancer detection and management, namely in differentiating cystic and solid masses, evaluating silicon breast implants and imaging patients under 30. Current-generation ultrasound systems provide improvements in image clarity, enhancements for biopsies and interventions and are targeting radiation therapy planning to the lumpectomy site.

Breast MRI, as Mitchell Schnall, MD, of the University of Pittsburgh Medical Center details in this month's Q&A (page 34), is the imaging method of choice for women at high risk of breast cancer and determining the number and extent of breast cancer tumors (studies show it to be more than twice as effective as mammography).

A six-year study at the University of Bonn backs up Schnall's accolades, suggesting that MR mammography should be adopted as a front-line screening test for women genetically predisposed to developing breast cancer. Women with mutations such as BRCA-1 and 2 have an increased lifetime risk of breast cancer of 80 to 90 percent and tend to develop breast cancer earlier in life than the general population, usually before 50. The cancers in this population also tend to be aggressive. Research shows that breast MR outperforms mammography and breast ultrasound in this targeted population, with overall sensitivity running 93 percent and specificity at 96 percent.

Together, digital mammography, breast ultrasound and breast MRI are detecting more breast cancers, often smaller and sooner, reducing patient anxiety with fewer recalls and quicker clinical decisions that facilitate better breast cancer treatment. That's progress.