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Breast imaging: Current trends and future direction, are we headed in the right way?

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Annual breast cancer screening with mammography is already recommended by the ACS. The ACS announced a new set of guidelines regarding breast cancer screening that supports the use of MRI in women that are at high risk of developing breast cancer.

Annual breast cancer screening with mammography is already recommended by the American Cancer Society. Due to recent data, in March 2007, the American Cancer Society announced a new set of guidelines regarding breast cancer screening that supports the use of MRI in women that are at high risk of developing breast cancer.

In a study published in the New England Journal of Medicine (Vol. 351, No. 5: 427-437), researchers suggest, "our study shows that the screening program we used, especially MRI screening, can detect breast cancer at an early stage in women at risk for breast cancer."

However patients need to "curb their enthusiasm", advises Dr. Jessica W. T. Leung, MD Assistant Professor of Radiology at the University of California San. Francisco. Despite the increase in detection "MR should be addition to, not instead of" she adds.

Studies have suggested that triple-negative breast cancer has a more aggressive clinical course than other forms of breast cancer.

In a retrospective study of 130 women diagnosed with triple-negative breast cancer, Dr. Christina Vieira and researchers from the New York University School of Medicine determined if differences in histologic grade translate to differences in nodal status among the triple negative breast cancers.

"There is a trend in breast imaging that size matters, however size does not matter in the predictability of lymph node involvement", states Vieira.

The histopathologic grade of the tumors was correlated with nodal status at presentation and research analysis showed five well-differentiated, 13 moderately-differentiated and 112 undifferentiated triple-negative breast cancers.

In Dr. Vieira's cohort of patients researchers concluded, 86.2 per cent of triple-negative breast carcinomas were found to be predominantly histologically undifferentiated and was a significant predictor of axillary metastasis in triple-negative breast cancer patients.

Women's breasts undergo extreme changes during lactation. Due to this physiological process, the changes can prove very difficult for both patients and physicians.

In a study to determine the accuracy of mammography and sonography in the evaluation of symptomatic pregnant and lactating women, Dr. Jessica Robbins and colleagues from the University of Michigan Medical School reviewed diagnostic breast imaging studies of 146 consecutive symptomatic pregnant and lactating women. Prospective BI-RADS assessment was used as truth and BI-RADS categories four and five were considered positive. In this study all sonographic examinations were performed by radiologists. Of the 155 lesions, 12 were evaluated by mammography alone, 62 by ultrasound, and 81 with both mammography and ultrasound.

"Under hormones many lesions become more prominent in these patients", says Robbins. In lactating women, Robbins found, while mammography was more specific, both mammography and sonography were sensitive for detection of breast cancer.

This year during the American Roentgen Ray Society meeting held in Washington DC one of the most admired subspecialty tracks offered was Breast Imaging.

Along with the cutting edge techniques offered throughout the scientific sessions, diagnostic and interventional radiologists alike, sought to optimize their expertise in breast ultrasound, digital mammography, tomosynthesis, breast MR, CT and the role nuclear imaging plays in breast imaging.

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