Breast Imaging

Breast imaging includes imaging modalities used for breast cancer screenings and planning therapy once cancer is detected. Mammography is the primary modality used. Mammogram technology is moving from 2D full-field digital mammography (FFDM) to breast tomosynthesis, or 3D mammography, which helps reduce false positive exams by allowing radiologists to look through the layers of tissue. Overlapping areas of dense breast tissue on 2D mammograms appear similar to cancers and 3D tomo helps determine if suspect areas are cancer or not. About 50% of women have dense breast tissue, which appears white on mammograms, the same as cancers, making diagnosis difficult. Radiologists use the Breast Imaging Reporting and Data System (BI-RADS) scoring system to define the density of breast tissue. Many states now require patients to be notified if they have dense breasts so they understand their mammograms might be suboptimal and they should use supplemental imaging that can see through the dense areas. This includes tomosythesis, breast ultrasound, automated breast ultrasound (ABUS), breast MRI, contrast enhanced mammography and nuclear imaging, including positron emission mammography (PEM).

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‘Controversial’ preoperative breast MRI more accurate than mammography/ultrasound for many patients

A third of breast-cancer patients undergoing preoperative mammography and ultrasound would be more accurately imaged for tumor size with breast MRI, according to a study published online April 13 in the Journal of Surgical Oncology. 

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Affordable breast MRI protocol improving detection in women with dense breasts

Via Radiology, based in Seattle, is the first in the Pacific Northwest to offer a new type of MRI screening for breast cancer patients.

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Danish study challenges value of screening mammography, draws sharp criticism from U.S. orgs

European researchers have reviewed a huge mammography dataset and found no association between screening mammography and a reduction in the incidence of advanced breast cancer. 

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Expanded genetic testing points more women to screening breast MRI

Testing for gene mutations beyond just BRCA1 and BRCA2 would indicate screening breast MRI and other proactive measures for many women who would not have been considered candidates for such measures going by family history alone, according to a large-sample study published online Dec. 21 in the Journal of the American College of Radiology.

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For high-risk women, even small lesions on breast MRI call for prompt assessment and biopsy

A U.K. study based on a departmental audit has confirmed previous research suggesting that MRI-detected small enhancing masses and new small enhancing foci, including those smaller than 5 millimeters, should be considered suspicious in women at high risk for breast cancer.

Comparison of a 2D digital mammogram and breast tomosynthesis 3D mammography from UCSF.

Breast density website reminds patients to dig deeper on internet searches

A website offering information about dense breasts, Dense Breast Info, wants women to be aware of their services, even though they aren’t always the first result in an internet search about breast density. 

Nonstandard patient positioning shows promise in intraoperative breast MRI

Intraoperative MRI for breast-tumor resection following presurgical MRI with the patient in the supine (“face up”) position can be used to effectively plan the extent of resection, detect residual tumor immediately after the first attempt at definitive lumpectomy and provide feedback to the surgeon within the surgical suite during a breast-conserving operation. 

Breast MRI detects more invasive cancers than mammography in high-risk women

Invasive breast cancers are more likely to be found through breast MRI screening rather than mammography in women with elevated risk factors, according to results of a study published online April 20 in the journal Radiology.

Around the web

CMS has more than doubled the CCTA payment rate from $175 to $357.13. The move, expected to have a significant impact on the utilization of cardiac CT, received immediate praise from imaging specialists.

The newly cleared offering, AutoChamber, was designed with opportunistic screening in mind. It can evaluate many different kinds of CT images, including those originally gathered to screen patients for lung cancer. 

AI-enabled coronary plaque assessments deliver significant value, according to late-breaking data presented at TCT. These AI platforms have gained considerable momentum in recent months, receiving expanded Medicare coverage in addition to a new Category I CPT code.

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