Breast cancer other imaging studies: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Breast cancer}} | {{Breast cancer}} | ||
{{CMG}}; {{AE}} {{Soroush}} | {{CMG}}; {{AE}} {{Soroush}}, Ammu Susheela | ||
==Overview== | ==Overview== | ||
Among all imaging modalities, mammography plays the key role in both screening and diagnosis of breast cancer. Mammography has been proven to reduce mortality from [[breast cancer]]. No other imaging technique has been shown to reduce risk. In some countries, routine (annual to five-yearly) mammography of older women is encouraged as a screening method to diagnose early breast cancer. Other diagnostic studies for breast cancer include modified [[Magnetic resonance imaging|MRI]] utilities (high-field strength MRI, magnetic resonance [[spectroscopy]], and diffusion weighted imaging, breast-specific [[Nuclear medicine|gamma imaging]], [[Positron emission tomography|positron emission]] mammography, scintimammography, [[Thermography (Sympathetic galvonic skin studies)|thermography]] and bone scan. | |||
==Scintimammography== | |||
* | ==Mammography== | ||
:*to check breast lumps that do not show up clearly on a mammogram because of: | '''Please click [[Mammography|<u>here</u>]] to navigate to the [[mammography|<u>mammography</u>]] page.''' | ||
::* | ==Scintimammography or breast-specific gamma imaging (BSGI)== | ||
::* | |||
::* | *Gamma cameras with 2 to 3 mm in-plane resolution in a [[Mammography|mammographic]] configuration are used | ||
:* | *Concept of BSGI is based on the accumulation of technetium-99m sestamibi in intracellular mitochondria of breast cancers cells.<ref name="pmid19914975">Jones EA, Phan TD, Blanchard DA, Miley A (2009) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19914975 Breast-specific gamma-imaging: molecular imaging of the breast using 99mTc-sestamibi and a small-field-of-view gamma-camera.] ''J Nucl Med Technol'' 37 (4):201-5. [http://dx.doi.org/10.2967/jnmt.109.063537 DOI:10.2967/jnmt.109.063537] PMID: [https://pubmed.gov/19914975 19914975]</ref> | ||
:* | |||
* | :*Compared to normal cells there is an increased number if intracellular mitochondria in breast cancer cells.<ref name="pmid24450668">Rechtman LR, Lenihan MJ, Lieberman JH, Teal CB, Torrente J, Rapelyea JA et al. (2014) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=24450668 Breast-specific gamma imaging for the detection of breast cancer in dense versus nondense breasts.] ''AJR Am J Roentgenol'' 202 (2):293-8. [http://dx.doi.org/10.2214/AJR.13.11585 DOI:10.2214/AJR.13.11585] PMID: [https://pubmed.gov/24450668 24450668]</ref> | ||
*'''Procedure''' | |||
:*First 25 mCi of technetium-99m sestamibi is being injected intravenously | |||
:*Following the injection of the radioisotope, The patient is scanned for 5 to 10 minutes. | |||
:*Mild breast compression is applied as of conventional mammography. | |||
:*Craniocaudal and mediolateral oblique views for each breast | |||
:*This is an adjuvant imaging method and hence images will be interpreted with respect to the patient's mammograms, ultrasounds, and clinical findings.<ref name="pmid18487533">Brem RF, Floerke AC, Rapelyea JA, Teal C, Kelly T, Mathur V (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18487533 Breast-specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer.] ''Radiology'' 247 (3):651-7. [http://dx.doi.org/10.1148/radiol.2473061678 DOI:10.1148/radiol.2473061678] PMID: [https://pubmed.gov/18487533 18487533]</ref> | |||
:*If indicated, BSGI compatible biopsy system is available to direct tissue sampling for the patients with small lesions not seen on other imaging modalities. | |||
*Compared to MRI, BSGI showed an equal sensitivity and higher specificity for the detection of breast cancer. | |||
*BSGI is recommended for use in the preoperative assessment of disease extension in breast cancer patients. or: | |||
:*To check breast lumps that do not show up clearly on a mammogram because of: | |||
::*Scar tissue from previous surgery or radiation therapy | |||
::*Dense breast tissue | |||
::*Breast implants | |||
:*When multiple tumors are seen in the breast | |||
:*To scan the lymph nodes in the armpit (axilla) to see if they contain cancer | |||
*Because of a very limited available DATA at the moment, '''BSGI is not recommended for screening or as a tool to exclude the likelihood of malignancy in suspicious breast masses or abnormal mammography.''' | |||
[[Image:Mammography and scintimammography of carcinoma.jpg|center|600px|thumb|'''Mammography and scintimammography of breast carcinoma. Images courtesy of''' Vassilios Papantoniou, Spyridon Tsiouris, Ekaterini Mainta, Varvara Valotassiou, Michael Souvatzoglou, Maria Sotiropoulou, Lydia Nakopoulou, Dimitrios Lazaris, Androniki Louvrou, Maria Melissinou, Artemis Tzannetaki, Ioannis Pirmettis, John Koutsikos and Cherry Zerva - "Imaging in situ breast carcinoma (with or without an invasive component) with technetium-99m pentavalent dimercaptosuccinic acid and technetium-99m 2-methoxy isobutyl isonitrile scintimammography". Breast Cancer Research 7 (1). DOI:10.1186/bcr948. PMC: 1064097., CC BY 2.0, <nowiki>https://commons.wikimedia.org/w/index.php?curid=58579597</nowiki>]] | |||
==Bone Scan== | ==Bone Scan== | ||
*A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It is used to see if breast cancer has spread ( | *A [[bone scan]] uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It is used to see if breast cancer has spread ([[Metastasis|metastasize]]<nowiki/>d) to the [[bone]]<nowiki/>s.<ref name="pmid28864931">Sugihara T, Koizumi M, Koyama M, Terauchi T, Gomi N, Ito Y et al. (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=28864931 Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors.] ''Ann Nucl Med'' 31 (10):719-725. [http://dx.doi.org/10.1007/s12149-017-1202-3 DOI:10.1007/s12149-017-1202-3] PMID: [https://pubmed.gov/28864931 28864931]</ref> | ||
*A bone scan may be done if: | *A bone scan may be done if:<ref name="pmid26834098">Cook GJ, Azad GK, Goh V (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=26834098 Imaging Bone Metastases in Breast Cancer: Staging and Response Assessment.] ''J Nucl Med'' 57 Suppl 1 ():27S-33S. [http://dx.doi.org/10.2967/jnumed.115.157867 DOI:10.2967/jnumed.115.157867] PMID: [https://pubmed.gov/26834098 26834098]</ref> | ||
:*Alkaline phosphatase in the blood is increased | :*Alkaline phosphatase in the blood is increased | ||
:*There are lymph nodes in the armpit (axillary lymph nodes) that can be felt | :*There are lymph nodes in the armpit (axillary lymph nodes) that can be felt | ||
| Line 21: | Line 40: | ||
:* The woman has aches and pains that may be caused by bone metastases | :* The woman has aches and pains that may be caused by bone metastases | ||
*A bone scan is not done in women who have stage I breast cancer. | *A bone scan is not done in women who have stage I breast cancer. | ||
==Thermography== | ==Thermography== | ||
*Digital infrared thermal imaging (DITI) is a type of thermography which is used in the screening of breast cancer | *Digital infrared thermal imaging (DITI) is a type of thermography which is used in the screening of breast cancer | ||
*An infrared thermal camera takes pictures of the areas of different temperature in the breasts. | *An infrared thermal camera takes pictures of the areas of different temperature in the breasts.<ref name="pmid27721713">Omranipour R, Kazemian A, Alipour S, Najafi M, Alidoosti M, Navid M et al. (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=27721713 Comparison of the Accuracy of Thermography and Mammography in the Detection of Breast Cancer.] ''Breast Care (Basel)'' 11 (4):260-264. [http://dx.doi.org/10.1159/000448347 DOI:10.1159/000448347] PMID: [https://pubmed.gov/27721713 27721713]</ref> | ||
*The camera displays these patterns as a sort of heat map. | *The camera displays these patterns as a sort of heat map. | ||
*Since the presence of cancerous growth is associated with the excessive formation of blood vessels and inflammation in the breast tissue. | *Since the presence of cancerous growth is associated with the excessive formation of [[Blood vessel|blood vessels]] and [[inflammation]] in the breast tissue. | ||
*On the infrared images, these higher temperatures could be detected. | *On the infrared images, these higher temperatures could be detected.<ref name="pmid30149621">Mambou SJ, Maresova P, Krejcar O, Selamat A, Kuca K (2018) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30149621 Breast Cancer Detection Using Infrared Thermal Imaging and a Deep Learning Model.] ''Sensors (Basel)'' 18 (9):. [http://dx.doi.org/10.3390/s18092799 DOI:10.3390/s18092799] PMID: [https://pubmed.gov/30149621 30149621]</ref> | ||
'''<big>Benefits</big>''' | '''<big>Benefits</big>''' | ||
*Non-invasive procedure | *Non-invasive procedure | ||
| Line 34: | Line 54: | ||
*It can be used for all women, including those with dense breast tissue and breast implants. | *It can be used for all women, including those with dense breast tissue and breast implants. | ||
*Hormonal changes do not affect results. | *Hormonal changes do not affect results. | ||
'''<big>Drawbacks</big>''' | '''<big>Drawbacks</big>'''<ref name="pmid23941008">Brkljacić B, Miletić D, Sardanelli F (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23941008 Thermography is not a feasible method for breast cancer screening.] ''Coll Antropol'' 37 (2):589-93. PMID: [https://pubmed.gov/23941008 23941008]</ref><ref name="pmid23941007">Kolarić D, Herceg Z, Nola IA, Ramljak V, Kulis T, Holjevac JK et al. (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23941007 Thermography--a feasible method for screening breast cancer?] ''Coll Antropol'' 37 (2):583-8. PMID: [https://pubmed.gov/23941007 23941007]</ref> | ||
*High false-positive rate | *High [[Type I and type II errors|false-positive rate]] | ||
*High false-negative rate | *High [[False negative|false-negative rate]] | ||
*Rarely covered by medical insurance | *Rarely covered by medical insurance | ||
*'''The high false-positive and false-negative rates associated with thermography often mean that the woman will need a standard mammogram anyway.''' | *'''The high [[Type I and type II errors|false-positive]] and [[Type I and type II errors|false-negative]] rates associated with thermography often mean that the woman will need a standard mammogram anyway.''' | ||
== | [[Image:BreastCancerRightSamplel.jpg|center|600px|thumb|'''Breast thermography.''' This is a high-resolution mid-range infrared image depicting cancer in the right breast by the high-energy blood vessels. Image courtesy of Philip P. Hoekstra, III, Ph.D.]] | ||
* | |||
: | ==Positron emission mammography== | ||
*''' | *'''PEM is still under investigation.''' | ||
:* | *High-resolution [[fluorodeoxyglucose]] PEM with compression with 2 mm in-plane resolution has been studied for detection of small malignancies <ref name="pmid20871992">Schilling K, Narayanan D, Kalinyak JE, The J, Velasquez MV, Kahn S et al. (2011) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20871992 Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging.] ''Eur J Nucl Med Mol Imaging'' 38 (1):23-36. [http://dx.doi.org/10.1007/s00259-010-1588-9 DOI:10.1007/s00259-010-1588-9] PMID: [https://pubmed.gov/20871992 20871992]</ref> <ref name="pmid23239242">Kalles V, Zografos GC, Provatopoulou X, Koulocheri D, Gounaris A (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23239242 The current status of positron emission mammography in breast cancer diagnosis.] ''Breast Cancer'' 20 (2):123-30. [http://dx.doi.org/10.1007/s12282-012-0433-3 DOI:10.1007/s12282-012-0433-3] PMID: [https://pubmed.gov/23239242 23239242]</ref> | ||
:* | *'''The procedure''' | ||
* | |||
:*This is a modified PET scan method and hence patients are prepared as for PET scan. | |||
:*Mild compression as of conventional mammography | |||
:*Craniocaudal and mediolateral oblique views for each breast | |||
:*This is an adjuvant imaging method and hence images will be interpreted with respect to the patient's mammograms, ultrasounds, and clinical findings. | |||
:*if indicated, PEM-compatible biopsy system is available to direct tissue sampling for the patients with small lesions not seen on other imaging modalities. | |||
:*Sensitivity 86 to 91 percent | |||
:*Specificity91 to 93 percent | |||
:*Major drawback is that PEM cannot reliably detect low-grade malignancies. | |||
:*Hence, '''PEM is not recommended for screening or as a tool to exclude the likelihood of [[Cancer|malignancy]] in suspicious breast masses or abnormal [[mammography]].''' | |||
:*Nevertheless PEM is promising for the preoperative assessment of disease extension<ref name="pmid23814402">Glass SB, Shah ZA (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23814402 Clinical utility of positron emission mammography.] ''Proc (Bayl Univ Med Cent)'' 26 (3):314-9. PMID: [https://pubmed.gov/23814402 23814402]</ref> | |||
[[Image:Positron Emission Mammography.jpg|center|600px|thumb|'''Positron emission mammography.''' By Yamamoto, Yayoi; Tasaki, Youichiro; Kuwada, Yukiko; Ozawa, Yukihiko; Katayama, Atsushi; Kanemaki, Yoshihide; Enokido, Katsutoshi; Nakamura, Seigo; Kubouchi, Kouichi; Morita, Satoshi; Noritake, Mutsumi; Nakajima, Yasuo; Inoue, Tomio - (2 July 2013). "Positron emission mammography (PEM): reviewing standardized semiquantitative method". Annals of Nuclear Medicine 27 (9): 795–801. DOI:10.1007/s12149-013-0748-y. PMC: 3830195., CC BY 4.0, <nowiki>https://commons.wikimedia.org/w/index.php?curid=65304896</nowiki>]] | |||
==Reference== | ==Reference== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 15:26, 15 October 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2], Ammu Susheela
Overview
Among all imaging modalities, mammography plays the key role in both screening and diagnosis of breast cancer. Mammography has been proven to reduce mortality from breast cancer. No other imaging technique has been shown to reduce risk. In some countries, routine (annual to five-yearly) mammography of older women is encouraged as a screening method to diagnose early breast cancer. Other diagnostic studies for breast cancer include modified MRI utilities (high-field strength MRI, magnetic resonance spectroscopy, and diffusion weighted imaging, breast-specific gamma imaging, positron emission mammography, scintimammography, thermography and bone scan.
Mammography
Please click here to navigate to the mammography page.
Scintimammography or breast-specific gamma imaging (BSGI)
- Gamma cameras with 2 to 3 mm in-plane resolution in a mammographic configuration are used
- Concept of BSGI is based on the accumulation of technetium-99m sestamibi in intracellular mitochondria of breast cancers cells.[1]
- Compared to normal cells there is an increased number if intracellular mitochondria in breast cancer cells.[2]
- Procedure
- First 25 mCi of technetium-99m sestamibi is being injected intravenously
- Following the injection of the radioisotope, The patient is scanned for 5 to 10 minutes.
- Mild breast compression is applied as of conventional mammography.
- Craniocaudal and mediolateral oblique views for each breast
- This is an adjuvant imaging method and hence images will be interpreted with respect to the patient's mammograms, ultrasounds, and clinical findings.[3]
- If indicated, BSGI compatible biopsy system is available to direct tissue sampling for the patients with small lesions not seen on other imaging modalities.
- Compared to MRI, BSGI showed an equal sensitivity and higher specificity for the detection of breast cancer.
- BSGI is recommended for use in the preoperative assessment of disease extension in breast cancer patients. or:
- To check breast lumps that do not show up clearly on a mammogram because of:
- Scar tissue from previous surgery or radiation therapy
- Dense breast tissue
- Breast implants
- When multiple tumors are seen in the breast
- To scan the lymph nodes in the armpit (axilla) to see if they contain cancer
- Because of a very limited available DATA at the moment, BSGI is not recommended for screening or as a tool to exclude the likelihood of malignancy in suspicious breast masses or abnormal mammography.
Bone Scan
- A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It is used to see if breast cancer has spread (metastasized) to the bones.[4]
- A bone scan may be done if:[5]
- Alkaline phosphatase in the blood is increased
- There are lymph nodes in the armpit (axillary lymph nodes) that can be felt
- The primary breast tumor is larger than 5 cm
- The woman has aches and pains that may be caused by bone metastases
- A bone scan is not done in women who have stage I breast cancer.
Thermography
- Digital infrared thermal imaging (DITI) is a type of thermography which is used in the screening of breast cancer
- An infrared thermal camera takes pictures of the areas of different temperature in the breasts.[6]
- The camera displays these patterns as a sort of heat map.
- Since the presence of cancerous growth is associated with the excessive formation of blood vessels and inflammation in the breast tissue.
- On the infrared images, these higher temperatures could be detected.[7]
Benefits
- Non-invasive procedure
- Non-contact procedure (does not compress the breast)
- No exposure to radiation, (safe)
- It can detect vascular changes in breast tissue associated with breast cancer many years in advance of other methods of screening.
- It can be used for all women, including those with dense breast tissue and breast implants.
- Hormonal changes do not affect results.
- High false-positive rate
- High false-negative rate
- Rarely covered by medical insurance
- The high false-positive and false-negative rates associated with thermography often mean that the woman will need a standard mammogram anyway.
Positron emission mammography
- PEM is still under investigation.
- High-resolution fluorodeoxyglucose PEM with compression with 2 mm in-plane resolution has been studied for detection of small malignancies [10] [11]
- The procedure
- This is a modified PET scan method and hence patients are prepared as for PET scan.
- Mild compression as of conventional mammography
- Craniocaudal and mediolateral oblique views for each breast
- This is an adjuvant imaging method and hence images will be interpreted with respect to the patient's mammograms, ultrasounds, and clinical findings.
- if indicated, PEM-compatible biopsy system is available to direct tissue sampling for the patients with small lesions not seen on other imaging modalities.
- Sensitivity 86 to 91 percent
- Specificity91 to 93 percent
- Major drawback is that PEM cannot reliably detect low-grade malignancies.
- Hence, PEM is not recommended for screening or as a tool to exclude the likelihood of malignancy in suspicious breast masses or abnormal mammography.
- Nevertheless PEM is promising for the preoperative assessment of disease extension[12]
Reference
- ↑ Jones EA, Phan TD, Blanchard DA, Miley A (2009) Breast-specific gamma-imaging: molecular imaging of the breast using 99mTc-sestamibi and a small-field-of-view gamma-camera. J Nucl Med Technol 37 (4):201-5. DOI:10.2967/jnmt.109.063537 PMID: 19914975
- ↑ Rechtman LR, Lenihan MJ, Lieberman JH, Teal CB, Torrente J, Rapelyea JA et al. (2014) Breast-specific gamma imaging for the detection of breast cancer in dense versus nondense breasts. AJR Am J Roentgenol 202 (2):293-8. DOI:10.2214/AJR.13.11585 PMID: 24450668
- ↑ Brem RF, Floerke AC, Rapelyea JA, Teal C, Kelly T, Mathur V (2008) Breast-specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer. Radiology 247 (3):651-7. DOI:10.1148/radiol.2473061678 PMID: 18487533
- ↑ Sugihara T, Koizumi M, Koyama M, Terauchi T, Gomi N, Ito Y et al. (2017) Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med 31 (10):719-725. DOI:10.1007/s12149-017-1202-3 PMID: 28864931
- ↑ Cook GJ, Azad GK, Goh V (2016) Imaging Bone Metastases in Breast Cancer: Staging and Response Assessment. J Nucl Med 57 Suppl 1 ():27S-33S. DOI:10.2967/jnumed.115.157867 PMID: 26834098
- ↑ Omranipour R, Kazemian A, Alipour S, Najafi M, Alidoosti M, Navid M et al. (2016) Comparison of the Accuracy of Thermography and Mammography in the Detection of Breast Cancer. Breast Care (Basel) 11 (4):260-264. DOI:10.1159/000448347 PMID: 27721713
- ↑ Mambou SJ, Maresova P, Krejcar O, Selamat A, Kuca K (2018) Breast Cancer Detection Using Infrared Thermal Imaging and a Deep Learning Model. Sensors (Basel) 18 (9):. DOI:10.3390/s18092799 PMID: 30149621
- ↑ Brkljacić B, Miletić D, Sardanelli F (2013) Thermography is not a feasible method for breast cancer screening. Coll Antropol 37 (2):589-93. PMID: 23941008
- ↑ Kolarić D, Herceg Z, Nola IA, Ramljak V, Kulis T, Holjevac JK et al. (2013) Thermography--a feasible method for screening breast cancer? Coll Antropol 37 (2):583-8. PMID: 23941007
- ↑ Schilling K, Narayanan D, Kalinyak JE, The J, Velasquez MV, Kahn S et al. (2011) Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging. Eur J Nucl Med Mol Imaging 38 (1):23-36. DOI:10.1007/s00259-010-1588-9 PMID: 20871992
- ↑ Kalles V, Zografos GC, Provatopoulou X, Koulocheri D, Gounaris A (2013) The current status of positron emission mammography in breast cancer diagnosis. Breast Cancer 20 (2):123-30. DOI:10.1007/s12282-012-0433-3 PMID: 23239242
- ↑ Glass SB, Shah ZA (2013) Clinical utility of positron emission mammography. Proc (Bayl Univ Med Cent) 26 (3):314-9. PMID: 23814402