Skip to main content

Advertisement

Log in

The choice of the correct imaging modality in breast cancer management

  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

This brief overview discusses which of the diagnostic options are more reliable and effective for breast cancer imaging with a view to avoiding the unjustified use of techniques that are suboptimal. The technological development of diagnostic imaging has been very impressive, and both radiological (mammography, ultrasonography, computed tomography, magnetic resonance imaging) and nuclear medicine tools (bone scan, planar and SPECT scintigraphy, sentinel node biopsy, positron emission tomography) have helped to overcome past limitations in the detection of small lesions. Furthermore, new approaches have been developed that permit successful differential diagnosis of doubtful lesions and rapid identification of systemic metastases, and allow non-invasive characterisation of the biology of cancer tissue. There is evidence that these advances may have helped in optimising therapeutic strategies. Importantly, the metabolic information provided by nuclear medicine procedures may be combined with the anatomical data supplied by radiological techniques in order to assist in predicting tumour response, planning radiotherapy and monitoring patient outcome. It is difficult to formulate conclusive diagnostic guidelines for application in the work-up of breast cancer, because while the role of some examinations, such as mammography and ultrasonography, is well established, that of others, such as magnetic resonance imaging and positron emission tomography, is still a matter of debate. There is a need for further prospective evaluations with appropriate clinical trials designed to evaluate the impact of these approaches in improving survival and quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hackshaw AK, Paul EA. Breast self-examination and death from breast cancer: a meta-analysis. Br J Cancer 2003; 88:1047–1053.

    Article  CAS  PubMed  Google Scholar 

  2. Cuzick J. Epidemiology of breast cancer—selected highlights. Breast 2003; 12:405–411.

    Article  PubMed  Google Scholar 

  3. Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evolution of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 202; 225:165–175.

    Google Scholar 

  4. Liang W, Lawrence WF, Burnett CB, Hwang YT, Freedman M, Trock BJ, Mandelblatt JS, Lippman ME. Acceptability of diagnostic tests for breast cancer. Breast Cancer Res Treat 2003; 79:199–206.

    Article  CAS  PubMed  Google Scholar 

  5. de Gery S, Perret F, Espie M, Frija J. Breast imaging and biopsy procedures in the diagnosis of breast cancer. Presse Med 2003; 25:125–133.

    Google Scholar 

  6. Morrow M. Magnetic resonance imaging in the preoperative evaluation of breast cancer: primum non nocere. J Am Coll Surg 2004; 198:240–241.

    Article  PubMed  Google Scholar 

  7. Madjar H, Ladner HA, Sauerbrei W, Oberstein A, Prompeler H, Pfleiderer A. Preoperative staging of breast cancer by palpation, mammography and high-resolution ultrasound. Ultrasound Obstet Gynecol 1993; 3:185–190.

    Article  CAS  PubMed  Google Scholar 

  8. Mehta TS. Current uses of ultrasound in the evaluation of the breast. Radiol Clin North Am 2003; 41:841–856.

    PubMed  Google Scholar 

  9. Prats E, Banzo J, Merono E, Herranz R, Carril JM, SMCSTMS.99mTc-MIBI scintimammography as a complement of the mammography in patients with suspected breast cancer. A multicentre experience. Breast 2001; 10:109–116.

    Article  CAS  PubMed  Google Scholar 

  10. Hata T, Takahashi H, Watanabe K, Takahashi M, Taguchi K, Itoh T, Todo S. Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography. J Am Coll Surg 2004; 198:190–197.

    Article  PubMed  Google Scholar 

  11. Hall FM. Mammography and sonography in young symptomatic women. AJR Am J Roentgenol 2003; 181:1424–1425.

    PubMed  Google Scholar 

  12. Wilczek B, Aspellin P, Bone B, Pegerfalk A, Frisell J, Danielsson R. Complementary use of scintimammography with99mTc-MIBI to triple diagnostic procedure in palpable and non-palpable breast lesions. Acta Radiol 2003; 44:288–293.

    Article  CAS  PubMed  Google Scholar 

  13. Adler LP, Weinberg IN, Bradbury MS, Levine EA, Lesko NM, Geisinger KR, Berg WA, Freimanis RI. Method for combined FDG-PET and radiographic imaging of primary breast cancer. Breast J 2003; 9:163–166.

    Article  PubMed  Google Scholar 

  14. Leconte I, Feger C, Galant C, Berliere M, Berg BV, D’Hoore W, Maldague B. Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. AJR Am J Roentgenol 2003; 180:1675–1679.

    PubMed  Google Scholar 

  15. Bedrosian I, Mick R, Orel SG, Schnall M, Reynolds C, Spitz FR, Callans LS, Buzby GP, Rosato EF, Fraker DL, Czerniecki BJ. Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 2003; 98:468–473.

    Article  PubMed  Google Scholar 

  16. Liberman M, Sampalis F, Mulder DS, Sampalis JS. Breast cancer diagnosis by scintimammography: a meta-analysis and review of the literature. Breast Cancer Res Treat 2003; 80:115–126.

    Article  CAS  PubMed  Google Scholar 

  17. Krishnaiah G, Sher-Ahmed A, Ugwu-Dike M, Regan P, Singer J, Totoonchie A, Spiegler E, Sardi A. Technetium-99m sestamibi scintimammography complements mammography in the detection of breast cancer. Breast J 2003; 9:288–294.

    Article  PubMed  Google Scholar 

  18. Smith IC, Gilbert FJ. Role of positron emission tomography in the management of breast cancer. Breast 1999; 8:303–310.

    Article  CAS  PubMed  Google Scholar 

  19. McDonough MD, DePeri ER, Mincey BA. The role of positron emission tomography imaging in breast cancer. Curr Oncol Rep 2004; 6:62–68.

    PubMed  Google Scholar 

  20. Czernin J. FDG-PET in breast cancer: a different view of its clinical usefulness. Mol Imaging Biol 2002; 4:35–45.

    Article  PubMed  Google Scholar 

  21. Vahabi M. Breast cancer screening methods: a review of the evidence. Health Care Women Int 2003; 24:773–793.

    Article  PubMed  Google Scholar 

  22. Crystal P, Strano SD, Shcharynski S, Koretz MJ. Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol 2003; 181:177–182.

    PubMed  Google Scholar 

  23. Brem RF, Baum J, Lechner M, Kaplan S, Souders S, Naul LG, Hoffmeister J. Improvement in sensitivity of screening mammography with computed-aided detection: a multiinstitutional trial. AJR Am J Roentgenol 2003; 181:687–693.

    PubMed  Google Scholar 

  24. Veronesi U, Paganelli G, Viale G, Galimberti V, Luini A, Zurrida S, Robertson C, Sacchini V, Veronesi P, Orvieto E, De Cicco C, Intra M, Tosi G, Scarpa D. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91:368–373.

    Article  CAS  PubMed  Google Scholar 

  25. Chao C, McMasters K. The current status of sentinel lymph node biopsy for breast cancer. Adv Surg 2000; 36:167–192.

    Google Scholar 

  26. Jakub JW, Pendas S, Reintgen DS. Current status of sentinel lymph node mapping and biopsy: facts and controversies. Oncologist 2003; 8:59–68.

    PubMed  Google Scholar 

  27. Greco M, Crippa F, Agresti R, Seregni E, Gerali A, Giovanazzi R, Micheli A, Asero S, Ferrarsi C, Genaro M, Bombardieri E, Cascinelli N. Axillary lymph node staging in breast cancer by 2-fluoro-2-deoxy-d-glucose positron emission tomography: clinical evaluation and alternative management. J Natl Cancer Inst 2001; 93:635–650.

    Article  PubMed  Google Scholar 

  28. Crowe JP Jr, Adler LP, Shenk RR, et al. Positron emission tomography and breast masses: comparison with clinical, mammographic, and pathological findings. Ann Surg Oncol 1994; 1:132–140.

    PubMed  Google Scholar 

  29. Noh DY, Yun IJ, Kim JS, et al. Diagnostic value of positron emission tomography for detecting breast cancer. World J Surg 1998; 22:223–227.

    Article  CAS  PubMed  Google Scholar 

  30. Smith IC, Ogston KN, Whitford P, et al. Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2-fluorine-18-fluoro-2-deoxy-d-glucose. Ann Surg 1998; 228:220–227.

    Article  CAS  PubMed  Google Scholar 

  31. Spanu A, Dettori G, Chessa F, Porcu A, Cottu P, Solinas P, Falchi A, Solinas ME, Scanu AM, Nuvoli S, Madeddu G.99mTc-tetrofosmin pinhole-SPECT (P-SPECT) and radioguided sentinel node (SN) biopsy and in breast cancer axillary lymph node staging. Cancer Biother Radiopharm 2001; 16:501–513.

    Article  CAS  PubMed  Google Scholar 

  32. Walter C, Scheidhauer K, Scharl A, Goering UJ, Theissen P, Kugel H, Krahe T, Pietrzyk U. Clinical and diagnostic value of preoperative MR mammography and FDG-PET in suspicious breast lesions. Eur Radiol 2003; 13:1651–1656.

    Article  CAS  PubMed  Google Scholar 

  33. Spanu A, Schillaci O, Meloni GB, Porcu A, Cottu P, Nuvoli S, Falchi A, Chessa F, Solinas ME, Madeddu G. The usefulness of99mTc-tetrofosmin SPECT scintimammography in the detection of small size primary breast carcinomas. Int Oncol 2002; 21:831–840.

    Google Scholar 

  34. Richie RC, Swanson JO. Breast cancer: a review of the literature. J Insur Med 2003; 35:85–101.

    PubMed  Google Scholar 

  35. Newman LA, Sabel M. Advances in breast cancer detection and management. Med Clin North Am 2003; 87:997–1028.

    PubMed  Google Scholar 

  36. Kubota M, Inoue K, Koh S, Sato T, Sugita T. Role of ultrasonography in treatment selection. Breast Cancer 2003; 10:188–197.

    PubMed  Google Scholar 

  37. Mille D, Roy T, Carrčre M.O, Ray I, Ferdjaoui N, Spath HM, Chauvin F, Philip T. Economic impact of harmonizing medical practices: compliance with clinical practice guidelines in the follow-up of breast cancer in a French comprehensive cancer center. J Clin Oncol 2000; 18:1718–1724.

    CAS  PubMed  Google Scholar 

  38. Williams A. How should information on cost effectiveness influence clinical practice. In: Delamothe T, ed. Outcomes into clinical practice. London: BMJ Publishing Group; 1994:99–107.

  39. Emens LA, Davidson NE. The follow-up of breast cancer. Semin Oncol 2003; 30:338–348.

    Article  PubMed  Google Scholar 

  40. Collins RF, Bekker HL, Dodwell DJ. Follow-up care of patients treated for breast cancer: a structured review. Cancer Treat Rev 2004; 30:19–35.

    Article  PubMed  Google Scholar 

  41. Hortobagyi GN. Can we cure limited metastatic breast cancer? J Clin Oncol 2002; 20:620–623.

    PubMed  Google Scholar 

  42. Mamounas EP. Ipsilateral breast tumour recurrence after lumpectomy: is it time to take the bull by the horns? J Clin Oncol 2001; 19:3798–3800.

    CAS  PubMed  Google Scholar 

  43. Tabar L, Dean PB. Mammography and breast cancer: the new era. Int J Gynaecol Obstet 2003; 82:319–326.

    Article  CAS  PubMed  Google Scholar 

  44. Zimmy M, Siggelkow W. Positron emission tomography scanning in gynecologic and breast cancers. Curr Opin Obstet Gynecol 2003; 15:69–75.

    Article  PubMed  Google Scholar 

  45. Czernin J. Clinical applications of FDG-PET in oncology. Acta Med Austriaca 2002; 29:162–170.

    Article  CAS  PubMed  Google Scholar 

  46. Siggelkow W, Zimny M, Faridi A, Petzold K, Buell U, Rath W. The value of positron emission tomography in the follow-up for breast cancer. Anticancer Res 2003; 23:1859–1867.

    PubMed  Google Scholar 

  47. Goerres GW, Michel SC, Fehr MK, Kaim AH, Steinert HC, Seifert B, von Schulthess GK, Kubik-Huch RA. Follow-up of women with breast cancer: comparison between MRI and FDG PET. Eur Radiol 2003; 13:1635–1644.

    Article  PubMed  Google Scholar 

  48. Peterson JJ, Kransdorf MJ, O’Connor MI. Diagnosis of occult bone metastases: positron emission tomography. Clin Orthop 2003; 415:S120–S128.

    PubMed  Google Scholar 

  49. Nakamoto Y, OSman M, Wahl RL. Prelevance and patterns of bone metastases detected with positron emission tomography using F-18 FDG. Clin Nucl Med 2003; 28:302–307.

    Article  PubMed  Google Scholar 

  50. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell 2000; 100:57–70.

    CAS  PubMed  Google Scholar 

  51. Mehta TS. Current uses of ultrasound in the evaluation of the breast. Radiol Clin North Am 2003; 41:841–856.

    PubMed  Google Scholar 

  52. Tuncbilek N, Unlu E, Karakas HM, Cakir B, Ozylmaz F. Evaluation of tumor angiogenesis with contrast-enhanced dynamic magnetic resonance mammography. Breast J 2003; 9:403–408.

    Article  PubMed  Google Scholar 

  53. Maidment AD. Digital mammography. Semin Roentgenol 2003; 38:216–230.

    PubMed  Google Scholar 

  54. Moretti JL, Azaloux H, Boisseron D, Kouyoumdjian JC, Vilcoq J. Primary breast cancer imaging with technetium-99m sestamibi and its relation with P-glycoprotein overexpression. Eur J Nucl Med 1996; 23:980–986.

    CAS  PubMed  Google Scholar 

  55. Kostakoglu L, Elahi N, Kiratli P, Ruacan S, Sayek I, Baltali E, Sungur A, Hayran M, Bekdik CF. Clinical validation of the influence of P-glycoprotein on technetium-99m-sestamibi uptake in malignant tumors. J Nucl Med 1997; 38:1003–1008.

    PubMed  Google Scholar 

  56. Del Vecchio S, Ciarmiello A, Potena MI, Carriero MV, Mainolfi C, Botti G, Thomas R, Cerra M, D’Aiuto G, Tsuruo T, Salvatore M. In vivo detection of multidrug-resistant (MDR1) phenotype by technetium-99m-sestamibi scan in untreated breast cancer patients. Eur J Nucl Med 1997; 24:150–159.

    PubMed  Google Scholar 

  57. Ciarmiello A, Del Vecchio S, Silvestro P, Potena MI, Carriero MV, Thomas R, Botti G, D’Aiuto G, Salvatore M. Tumor clearance of technetium-99m-sestamibi as a predictor of response to neoadjuvant chemotherapy for locally advanced breast cancer. J Clin Oncol 1998; 16:1677–1683.

    CAS  PubMed  Google Scholar 

  58. Avril N, Schelling M, Dose J, Weber WA, Schwaiger M. Utility of PET in breast cancer. Clin Positron Imaging 1999; 2:261–271.

    Article  PubMed  Google Scholar 

  59. Maisey MN. Overview of clinical PET. Br J Radiol 2002; 75:S1–S5.

    PubMed  Google Scholar 

  60. Crippa F, Seregni E, Agresti R, Chiesa C, Pascali C, Bogni A, Decise D, De Sanctis V, Greco M, Daidone MG, Bombardieri E. Association between [18F]fluorodeoxyglucose uptake and postoperative histopathology, hormone receptor status, thymidine labelling index and p53 in primary breast cancer: a preliminary observation. Eur J Nucl Med 1998; 25:1429–1434.

    CAS  PubMed  Google Scholar 

  61. Knopp MV, von Tengg-Kobligk H, Choyke PL. Functional magnetic resonance imaging in oncology for diagnosis and therapy monitoring. Mol Cancer Ther 2003; 2:419–426.

    CAS  PubMed  Google Scholar 

  62. Pondero V, Mazzocchi M, Del Frate C, Pugliesi F, Di Loreto C, Francescutti G, Zuiani C. Locally advanced breast cancer: comparison of mammography sonography and MR imaging in evaluation of residual disease women receiving neoadjuvant chemotherapy. Eur Radiol 2004:in press.

  63. Morakkabati N, Leutner CC, Schmiedel A, Schild HH, Kuhl CK. Breast MR imaging during or soon after radiation therapy. Radiology 2003; 229:893–901.

    PubMed  Google Scholar 

  64. Bombardieri E, Crippa F. The increasing impact of PET in the diagnostic work-up of cancer patients. In: Freeman LM, ed. Nuclear medicine annual 2002. Philadelphia: Lippincott Williams & Wilkins; 2002:75–121.

  65. Mariani G, Gennai A, Giorgetti A, Donati S, Puccini G, Nista N, Dani D, Bengala C, Conte PF, Salvatori PA. Early assessment by PET with FDG of response to first-line chemotherapy of metastatic breast cancer. Clin Positron Imaging 1999; 2:342.

    Article  PubMed  Google Scholar 

  66. Krak NC, van der Hoeven JJ, Hoekstra OS, Twisk JW, van der Wall EE, Lammertsma AA. Measuring18F-FDG uptake in breast cancer during chemotherapy: comparison of analytical methods. Eur J Nucl Med Mol Imaging 2003; 30:674–681.

    CAS  PubMed  Google Scholar 

  67. Kostakoglu L, Goldsmith SJ.18F-FDG PET evaluation of the response to therapy for lymphoma and for breast, lung, and colorectal carcinoma. J Nucl Med 2003; 44:224–239.

    PubMed  Google Scholar 

  68. Donckier V, Van Laethem JL, Goldman S, Van Gansbeke D, Feron P, Ickx B, Wikler D, Gelin M. F-18 fluorodeoxyglucose positron emission tomography as a tool for early recognition of incomplete tumor destruction after radiofrequency ablation for liver metastases. J Surg Oncol 2003; 84:215–223.

    Article  PubMed  Google Scholar 

  69. Inoue T, Butani K, Taguchi T, Tamaki Y, Shiba E, Noguchi S. Preoperative evaluation of prognosis in breast cancer patients with (18F)2-deoxy-2-fluoro-d-glucose-positron emission tomography. J Cancer Res Clin Oncol 2004:in press.

Download references

Acknowledgements

The authors are grateful to Ms Annaluisa De Simone Sorrentino for her kind editorial help in preparing this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emilio Bombardieri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bombardieri, E., Gianni, L. The choice of the correct imaging modality in breast cancer management. Eur J Nucl Med Mol Imaging 31 (Suppl 1), S179–S186 (2004). https://doi.org/10.1007/s00259-004-1541-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-004-1541-x

Keywords

Navigation