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Advanced approaches to imaging primary breast cancer: an update

  • Systematic Review
  • Published:
Clinical and Translational Imaging Aims and scope Submit manuscript

Abstract

Purpose

Breast cancer (BC) is the most common cancer in women. Early detection of BC plays an important role in preventing advanced disease and improving survival. In this article, we aim to describe both advantages and limitations of conventional and new BC-imaging modalities.

Methods

A literature search was performed for the period of January 2013 through October 2018, using search engines such as PubMed, PMC, and Google scholar. Search topics included: “breast cancer”, “breast lesion”, and “breast tumor imaging, diagnosis, and detection”.

Results

A total of 143 papers which primarily addressed imaging efficacy issues are included in the review. Mammography is the oldest and most commonly utilized screening modality for BC. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission mammography (PEM), and positron emission tomography/computed tomography (PET/CT) are the other conventional BC-imaging modalities. To overcome certain weaknesses of these modalities, new imaging tools including contrast-enhanced spectral mammography (CSEM), digital breast tomosynthesis (DBT), multiparametric (MP)-MRI, microwave imaging, and PET/MRI have been investigated.

Conclusion

Conventional BC-imaging modalities have both advantages and limitations. When utilized in combination, they are often complementary. For example, a limitation of mammography is low sensitivity in dense breasts. The addition of DBT lessens this limitation by providing three-dimensional (3D) images of the breast that minimizes the effect of overlying breast tissue. Additionally, US added to mammography in dense breasts increases screening sensitivity and has the advantages of accessibility and lack of ionizing radiation. MRI is currently the most sensitive method used for detecting BC. When MRI is not suitable for patients, such as those with prosthesis, dedicated breast CT can be used. Scintimammography is another alternative method, although not commonly performed due to low sensitivity in < 1 cm tumors. Breast-specific gamma imaging (BSGI), on the other hand, can detect breast tumor < 1 cm; however, effective radiation dose is higher than mammography. PEM, with its high resolution, has been developed to image small breast tumors. PET/CT and PET/MRI have also been used to detect BC. Despite complementary roles of conventional imaging techniques, none of them have addressed all issues in BC diagnosis. Research studies developing novel target-specific molecular imaging agents are in progress with hopes to fill gaps in currently available imaging technologies.

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Abbreviations

ACR:

American College of Radiology

ACS:

American Cancer Society

ADC:

Apparent diffusion coefficient

Anti-3-18F-FACBC:

Anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid

Anti-3-18F-FACBC:

18Fluorine-fluciclovine

Arg-Gly-Asp (RGD):

Arginine–glycine–aspartic acid

BBN:

Bombesin

BC:

Breast cancer

BGO:

Bismuth germanium oxide

BI-RADS:

Breast Imaging Reporting and Data System

BMI:

Body mass index

BPE:

Background parenchymal enhancement

BSGI:

Breast-specific gamma imaging

CE:

Contrast enhanced

CESM:

Contrast-enhanced spectral mammography

CT:

Computed tomography

64Cu:

64Copper

D:

Dimensional

DBT:

Digital breast tomosynthesis

DCE:

Dynamic contrast enhanced

DCIS:

Ductal carcinoma in situ

DM:

Digital mammography

DWI:

Diffusion-weighted imaging

E-[c(RGDfK)]2:

Arginine–glycine–aspartic acid dimer peptide

EDDA:

Ethylenediamine-N,N’-diacetic acid

ER:

Estrogen receptor

18F-FDG:

18Fluorine-2-deoxy-d-glucose

18F-FES:

16α-18Fluorine-fluoroestradiol

18F-FLT:

3′-Deoxy-3′-18fluorine-fluorothymidine

18F-4FMFES:

4-Fluoro-11β-methoxy-16α-18fluorine-fluoroestradiol

FDA:

Food and Drug Administration

FFDM:

Full-field digital mammography

FGT:

Fibroglandular tissue

FN:

False negative

FP:

False positive

GRPR:

Gastrin-releasing peptide receptor

GSO:

Gadolinium oxyorthosilicate

1H-MRS:

Proton MR spectroscopy

HYNIC:

Hydrazinonicotinamide

IAEA:

International Atomic Energy Agency

In:

Indium

i.v.:

Intravenous

KBCT:

Koning Breast CT

L/N:

Lesion to non-lesion ratio

LN:

Lymph node

LYSO:

Lutetium yttrium orthosilicate

LW1:

Lipid line width for methylene resonance

LW2:

Lipid line width for methyl peaks

MAMMI:

MAMmography with Molecular Imaging

MIBI:

Methoxyisobutylisonitrile

MP:

Multiparametric

MRI:

Magnetic resonance imaging

mRNA:

Mesenger RNA

n:

Number

NA:

Not available

NCI:

National Cancer Institute

NCNN:

National Comprehensive Cancer Network

NPV:

Negative predictive value

P:

Phosphorus

PEM:

Positron emission mammography

PET:

Positron emission tomography

PPV:

Positive predictive value

PR:

Progesterone receptor

Pr:LuAG:

Praseodymium-doped lutetium aluminum garnet

Pts:

Patients

PUVmax:

Maximum PEM uptake value

Ref.:

Reference

RGD:

Arginine–glycine–aspartic acid

ROC:

Receiver-operating characteristics

RS-EPI:

Readout-segmented echo-planar imaging

Sens.:

Sensitivity

SNR:

Signal-to-noise ratio

Spe.:

Specificity

SPECT:

Single-photon emission computed tomography

SS-EPI:

Single-shot echo-planar imaging

SSTR:

Somatostatin receptor

SUVmax:

Maximum standardized uptake value

T:

Tesla

T/N:

Tumor to non-tumor

T1-W:

T1 weighted

T2-W:

T2 weighted

tCho:

Total choline peak

99mTc:

99mTechnetium

99mTc-3 Poly-ethylene glycol 4:

99mTechnetium-3P-RGD2

US:

Ultrasonography

USPSTF:

United States Preventive Services Task Force

WB:

Whole body

WI:

Weighted imaging

WF1:

Water fraction 1

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Acknowledgements

Dr. Ebru Salmanoglu is the visiting scholar to the Thakur laboratories and thanks The Scientific and Technological Research Council of Turkey (TÜBİTAK) for their fellowship and Dr. Thakur for his teaching and support. Dr. Thakur thanks, NIH CA 109231 and NIH/NCI RO1CA157372, awards that in part supported the preparation of this review. The skillful assistance of Ms. Kim Lee is gratefully acknowledged.

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  1. Department of Radiology, Thomas Jefferson University, 1020 Locust Street, Suite 359-JAH, Philadelphia, PA, 19107, USA

    Ebru Salmanoglu, Kimberly Klinger, Chandni Bhimani, Alexander Sevrukov & Mathew L. Thakur

  2. Department of Nuclear Medicine, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Avsar Kampus, Kahramanmaras, 46040, Turkey

    Ebru Salmanoglu

  3. Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Mathew L. Thakur

  4. Department of Urology, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Mathew L. Thakur

  5. Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Mathew L. Thakur

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Salmanoglu, E., Klinger, K., Bhimani, C. et al. Advanced approaches to imaging primary breast cancer: an update. Clin Transl Imaging 7, 381–404 (2019). https://doi.org/10.1007/s40336-019-00346-z

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