Imaging techniques in breast cancer

Radiology, along with clinical examination and the pathological results, is a fundamental aspect of the triple assessment of patients with breast disease, particularly those with breast cancer. In addition to long established imaging techniques such as mammography and breast ultrasound in the symptomatic patient, there are now many developing technologies which assist in making and confirming the diagnosis (eg digital tomography, MRI) and in helping the surgeon and oncologist decide on the best treatment plan (eg positron emission tomography).

In mammographic screening, small impalpable lesions are identified and assessed. The use of image guided biopsy optimizes preoperative diagnosis in these women. Confirmed screen detected cancers are frequently impalpable and may require preoperative marking by the radiologist (wire localization) to enable the surgeon to identify the lesion in the operating theatre.

Sentinel node surgery in the axilla is enhanced by the use of scintimammography allowing identification of the first lymph nodes draining the breast hence minimizing subsequent surgical morbidity.

MRI is important in evaluating patients with a high risk of breast cancer due to family history etc., where mammography may be inadequate and also in certain scenarios eg those patients with lobular cancers, as it is more able to accurately size the lesion and inform surgical planning.