It can be challenging to find a brief, current review on cutting edge topics. Here we provide "white papers," which are brief overviews on current topics written by Society members who are experts in these areas. The topics of the white papers will vary over time depending upon what is new, evolving, or of current interest. All papers have undergone review by the SBI Scientific Advisory Committee and approved by the SBI Board of Directors. We hope that you will find these helpful.
Unless otherwise stated, the content of the white papers reflects the perspective of the authors and not necessarily the position of the Society of Breast Imaging.
Author: Wendie A. Berg, MD, PhD, FACR, FSBI
Interest in nuclear medicine-based breast imaging is increasing as advances in technology allow for lower dose of radiotracer and confirm high sensitivity for the detection of in-breast cancers. These tools may have roles as we develop tailored breast imaging in our efforts to provide personalized, value-based care for our patients.
Screening mammography has been shown to reduce breast cancer mortality in randomized clinical trials. It has been an effective screening test for the past 4 decades due to its short exam time, patient convenience and low cost. The sensitivity of mammography for the detection of cancer in screening populations ranges from approximately 60% to more than 90% depending on breast density, meaning that in the densest breasts, 4 of 10 cancers will not be detected by screening mammography prior to their becoming palpable (1).
The purpose of this paper is to address the importance of physiologic imaging for the staging and follow up of patients with breast cancer according to the principles of precision medicine. Precision medicine is the “tailoring of medical treatment to the individual characteristics, needs and preferences of a patient during all stages of care, including prevention, diagnosis, treatment and follow-up.” Currently, physiologic imaging is primarily performed with 18F –FDG- PET/CT, but other tracers are increasingly being used towards the goal of more specific tumor targeting.
Dense breast tissue is common and normal. About 40% of women over the age of 40 years have dense breasts (1). Dense breasts are more common in younger women and the breasts tend to become more replaced by fat as the glands involute after menopause. Dense breast tissue reduces the effectiveness of mammography and increases the risk for developing breast cancer.
Digital breast tomosynthesis (DBT), which was FDA approved in 2011, is rapidly emerging as the new standard of care for x-ray imaging of the breast. Multiple studies have shown that when DBT is coupled with conventional 2D mammography, improvements in both sensitivity and specificity are achieved for screening and diagnostic breast imaging.