Emerging techniques in breast imaging

As a service to "promote state-of-the-art cancer care" Elsevier does expert commentary periodically.  Recently, Dr. Maxine Jochelson, the Director of Radiology, Breast and Imaging Center, at Memorial SLoan-Kettering Cancer Center in NY discussed emerging breast imaging.  See http://www.oncologystat.com/viewpoints/commentary/Update_on_Emerging_Techniques_in_Breast_Imaging.html.


Of note to me, are two nuclear studies because they are functional assessments of breast lesions at a cellular or molecular level, not just a "picture" of the tissues.


It should be noted, that she reminds us all that mammography does save lives and the reduction in mortality due to screening mammography, looking at all studies, is 30%.


Different from mammography, which is the standard breast screening are the two radionuclide studies.  Each requires IV injection and radiation exposure to organs other that the breast.  They are relatively new and she points out that each is promising and may have a roll in diagnosis, but probably not screening.


Breast-specific gamma imaging (BSGI) uses technetium-99m sestamibi.  The gamma counter "sees" the sestamibi in the mitochondria of the cells.  Cancer cells generally have more than normal cells and are "hot".


Positron emission mammography (PEM) is basically a PET scan of the breast.  The  fluorine-18 labelled deoxyglucose (FDG) that is injected then accumulates in tumor cells, actively metabolizing glucose. 


In small studies each has shown a specificity of around 90%, but the key will be lowering the radiation dose and perhaps increasing the sensitivity of the receivers  picking up the signal.




We are talking about finding a small number of additional cancers and we should remember that neither has replaced mammography as a screening tool.


There are additional ultrasound techniques which will be reviewed later.