Rani Gupta Sah*, Arooj Aftab, Rajesh Prasad Sah, Pankaj Shah and Jay Prakash


Background: The imaging is crucial component not only for breast cancer screening, but also for diagnosis, evaluation, treatment, and follow-up of patients with breast cancer. Methods: The author reviews the current prospective and provides her personal views in describing the status of various imaging modalities such as mammography, computer-aided detection, ultrasonography dedicated magnetic resonance imaging, Magnetic resonance spectroscopy (MRS), positron-emission mammography and technologies under research for evaluating the breast detection and diagnosis. Results: Mammography is the unsurpassed screening modality for asymptomatic women and the initial imaging modality for symptomatic women. The advent of digital mammography may likely upgrade its sensitivity and specificity in women under 50 years of age and in those with dense breasts compared standard mammography. Computer-aided detection assists in experienced mammographers and enhances detection of microcalcifications in dense breasts. USG is used for characterization of the mammographic abnormality and for primary imaging of young women <30 years. Magnetic resonance elastography need further studies to establish their roles. Breast magnetic resonance imaging (MRI) provides anatomical and physiologic tissue features. It is useful in preoperative evaluation, clarification of indeterminate mammograms, and follow-up of BRCA mutation carriers. Contrast enhanced MRI is so far the most sensitive technology for the diagnosis of malignancy at the expense of reduced specificity. However. diffusion, and MR elastography have been applied to breast lesion characterization and show promise. The addition of MR Spectroscopy (MRS) can improve its specificity. In-vivo MRS is a valuable method to obtain the biochemical status of normal and diseased tissues. Malignant tissues contain a high concentration of choline-containing compounds that can be used as a biochemical marker. Molecular imaging can be useful in a select group of patients like those with suspected distant metastases, to evaluate loco regional extent, to detect the recurrence and monitor response to therapy. Positron-emission mammography promises enhanced detection of ductal carcinoma in situ, even when not associated with microcalcifications, and should aid surgical planning. Optical imaging and T Scan currently under research have potential to emerge as an adjunct to the existing technologies. Conclusions: This review presents the progress made in different imaging techniques in breast cancer screening, diagnosis and detection. The ideal modality for breast imaging should lead to early detection of cancer, free from adverse effects and cost effective. The advances in breast imaging have improved the sensitivity of detecting breast abnormalities. However, cost may be major limiting factors for the extensive application of some of these advances in the clinical backgrounds. The clinician needs to be aware of the benefits and weaknesses of each technology in order to apply them appropriately in evaluating their patients with breast problems in the clinical settings.

Keywords: Breast cancer, Digital mamography, Computer aided diagnosis, Ultrasound, MRI, MR elastography (MRE), magnetic resonance spectroscopy (MRS), Molecular Imaging and Technologies under research.

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