Breast cancer other imaging studies

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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, M.D. [3]

Overview

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.

Scintimammography or breast-specific gamma imaging (BSGI)

• Scintimammography uses a radioactive material (known as a radioactive isotope) and a special camera to take pictures of the breast. It is done:

• 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

• Scintimammography is not commonly used. It does not replace mammography, which is still the standard imaging test used to diagnose breast cancer. At present, scintimammography is considered a second-line diagnostic tool. It may be used in some women to assess breast abnormalities after a mammogram.

• 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.

• Compared to normal cells there is an increased number if Intracellular mitochondria in breast cancer cells.

• 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.
• 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
• 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.

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, https://commons.wikimedia.org/w/index.php?curid=58579597

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.
• A bone scan may be done if:

• 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.
• 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.

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.

Drawbacks

• 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.

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
• 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

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, https://commons.wikimedia.org/w/index.php?curid=65304896