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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87% of mammography centers now have 3D breast imaging systems

Rapid adoption of digital breast tomosynthesis has increasingly made it a new standard of care.

A comparison of standard 2D mammography (right) and digital breast tomosynthesis (DBT), or 3D mammography (left). The DBT creates a data set of 1 mm slices that the radiologist can look through to see more detail in suspect areas and determine if it dense breast tissue is masking a tumor.

Standalone AI excels at reading digital mammograms, but how does it hold up with DBT exams?

Standalone AI can significantly outperform radiologists' sensitivity in reading digital mammograms and has shown potential in DBT exams as well, but experts are not yet ready to hand over the reins.

lesion on breast ultrasound

CAD software is especially beneficial for radiologists in rural settings

Judging the software’s utility in rural settings with less experienced readers is important for expanding access to and improving care for patients, authors of a new AJR paper noted.

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'Visual hindsight bias': What it is and how it affects lawsuits against radiologists

This psychological phenomenon describes the notion that people believe they can make better predictions or decisions once they have been exposed to new information on the subject, often causing them to overestimate their own abilities. 

black woman breast cancer pink ribbon

Experts cite 'urgent need' for changes to USPSTF breast cancer screening recommendations

The USPSTF’s update suggests that women should screen every other year, but the group's own modeling studies have cited the benefits of annual screening.

Katie Couric on USPSTF recommendations on when women should start getting mammograms

'Kind of a bummer': Katie Couric disappointed in USPSTF recs that exclude supplementary imaging for dense breasts

The task force cited insufficient evidence as the driver behind the decision to forego recommending supplemental screening. 

Sagittal images from breast MRI in a 36-year-old woman with an invasive ductal carcinoma. Image from pre-chemotherapy contrast-enhanced T1-weighted MRI shows a round, rim-enhancing mass. This  subtraction image shows the maximal diameter of the mass was measured up to 5.4 cm. Read more. RSNA image. What does breast cancer look like?

Researchers identify MRI findings linked with invasive breast cancer

Researchers suggested these findings could be used as a noninvasive tool in creating more personalized treatment options for patients facing a cancer diagnosis that is invasive in nature. 

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Breast cancer risk assessments should account for longitudinal changes in breast density, new data suggest

Breast density is known to drop over time, but the rate at which density decreases merits special attention, as it could be associated with a woman’s chance of developing cancer.

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