Molecular Breast Imaging: An emerging alternative?

Justine Cadet, Editorial Director

As with every November, this year’s Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) reinvigorated the imaging community. This year, in particular, molecular imaging took center stage, as a plethora of education sessions, scientific papers and keynote speakers focused on the benefits garnered from using nuclear medicine to detect disease, target therapy and monitor response in a personalized manner.

Specific to the breast imaging community, recent clinical data have come forth to indicate some of the shortcomings with mammography, breast MR and ultrasound.

At RSNA, Wendie A. Berg, MD, PhD, visiting professor at the University of Pittsburgh School of Medicine, presented a retrospective analysis--the ACRIN [American College of Radiology Imaging Network] 6666 trial, which found that errors in interpretation of ultrasound screening of breast cancer were similar in prevalence (21 percent of misses) to errors in mammographic and MRI interpretation. 

Berg noted that the comparable rate of missed cancers with mammography was “surprising” adding that the “similar rates of errors across all modalities…is important to consider.”

Also, findings from a 15-year trial, published Dec. 8 in British Medical Journal, suggest that screening mammography may do more harm than good. The researchers combined the benefits and harms of screening in one single measure and based the study on 100,000 women, ages 50 and older, surviving by year up to 20 years after entry to the screening program. After 20 years, net quality-adjusted life years accumulate, but by much less than predicted by the highly publicized 1986 Forrest report.

Another well-touted concern with mammography is its ineffectiveness in women with dense breasts. Thus, a few states, such as Connecticut, have passed legislation requiring the recommendation of an ultrasound exam for these women.

However, a few facilities, like Mayo Clinic in Rochester, Minn., and Toledo Hospital Breast Care Center in Ohio, have begun to employ molecular breast imaging for women with dense breasts. Recent iterations of the algorithm technology have reduced the radiation to 4 mCi, with the same image quality produced at 20 mCi, making a viable—and potentially cost-effective—alternative.

If you want to share how the recent RSNA conference has influenced your practice, please let us know.

Justine Cadet
jcadet@trimedmedia.com