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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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.

Save time, catch cancer with abbreviated breast MRI protocols

Abbreviated MRI protocols are just as effective as full diagnostic protocols at detecting cancers and also save valuable time and resources for both patients and facilities, according to results of a study published online in the Journal of the American College of Radiology.

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Study examines mismatch between breast MRI BI-RADS assessments, clinical recommendations

Breast MRI examinations assessed using BI-RADS guidelines don’t always coincide with expected clinical management recommendations, according to results of a study published online in the American Journal of Roentgenology.

Architectural distortion seen in the breast of a 67-year-old woman who presented for screening mammography. Surgical pathology revealed invasive ductal adenocarcinoma. Image from AJR

When does worrisome architectural distortion signal malignancy on mammography?

Architectural distortion, the non-mass but potentially ominous clinical feature observed in many breast imaging procedures, is less likely to signal malignancy when it’s detected on screening mammography rather than diagnostic mammography or when it does not correlate with a subsequent targeted ultrasound exam.

Annual Mammography Starting at Age 40 Still Best Way to Saves Lives from Breast Cancer

The American College of Radiology (ACR), Society of Breast Imaging (SBI) and major medical organizations experienced in breast cancer care continue to recommend that women start getting annual mammograms at age 40.

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False-positives and fear

Research has once again shown that false-positive screening mammography results lead to increased anxiety for the women that receive them, and that these feelings can last for months. But how much should we fear the fear itself?

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