Breast imaging in the new era

Reference breast temperature: proposal of an equation

OBJECTIVE

To develop an equation to estimate the breast reference temperature according to the variation of room and core body temperatures.

METHODS

Four asymptomatic women were evaluated for three consecutive menstrual cycles. Using thermography, the temperature of breasts and eyes was measured as indirect reference of core body and room temperatures. To analyze the thermal behavior of the breasts during the cycle, the core body and room temperatures were normalized by means of a mathematical equation.

RESULTS

We performed 180 observations and the core temperature had the highest correlation with the breast temperature, followed by room temperature. The proposed prediction model could explain 45.3% of the breast temperature variation, with variable room temperature variable; it can be accepted as a way to estimate the reference breast temperature at different room temperatures.

CONCLUSION

The average breast temperature in healthy women had a direct relation with the core and room temperature and can be estimated mathematically. It is suggested that an equation could be used in clinical practice to estimate the normal breast reference temperature in young women, regardless of the day of the cycle, therefore assisting in evaluation of anatomical studies.

Optical imaging for breast cancer prescreening

Breast cancer prescreening is carried out prior to the gold standard screening using X-ray mammography and/or ultrasound. Prescreening is typically carried out using clinical breast examination (CBE) or self-breast examinations (SBEs). Since CBE and SBE have high false-positive rates, there is a need for a low-cost, noninvasive, non-radiative, and portable imaging modality that can be used as a prescreening tool to complement CBE/SBE. This review focuses on the various hand-held optical imaging devices that have been developed and applied toward early-stage breast cancer detection or as a prescreening tool via phantom, in vivo, and breast cancer imaging studies. Apart from the various optical devices developed by different research groups, a wide-field fiber-free near-infrared optical scanner has been developed for transillumination-based breast imaging in our Optical Imaging Laboratory. Preliminary in vivo studies on normal breast tissues, with absorption-contrasted targets placed in the intramammary fold, detected targets as deep as 8.8 cm. Future work involves in vivo imaging studies on breast cancer subjects and comparison with the gold standard X-ray mammography approach.

The Emerging Role of Elastography in Cancer

Real-time elastography is an emerging sonographic imaging technique that provides a noninvasive method of evaluating biomechanical properties of a lesion: specifically, the elasticity, or stiffness, of the cellular composition relative to surrounding tissue. Clinical studies have demonstrated the diagnostic capability of elastography to detect specific cancers with accuracy that may substantially affect patient care and improve outcome. This literature review examines the basics of elastography, the advantages and limitations of this technique, and the results of research centered on its role in cancer detection and evaluation of tissue response to cancer therapies.

99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer

OBJECTIVE

Mammography has been established as the gold standard for the detection of breast cancer, and imaging techniques such as ultrasonography, magnetic resonance imaging, scintigraphy and positron emission tomography may be useful to improve its sensitivity and specificity. The objective of this study with breast scintigraphy was to evaluate the uptake of 99mTc-thymine in mammary lesions.

METHODS

A total of 45 patients were included in this study. Thirty-three patients (73%) were subjected to surgery or percutaneous biopsy, providing histopathological data. The other 12 patients who remained under surveillance received clinical examinations and biannual mammography with a normal follow-up of at least three years, the data from which were used for comparison with the scintimammography results.

RESULTS

The majority of patients (64.4%) had clinically impalpable lesions with a mammogram diagnosis of microcalcifications, impalpable nodules, or focal asymmetry. Of the studied lesions, 87% were smaller or equal to 20 mm in diameter, and 22% had malignant histopathological findings. Scintigraphy with 99mTc-thymine had a sensitivity of 70%, a specificity of 85.7%, positive and negative predictive values of 58.3% and 90.9%, respectively, and an accuracy of 82.2%.

CONCLUSIONS

The results of this study are consistent with those previously reported by other authors. The good specificity and high negative predictive value of this technique and the absence of uptake in the heart indicate that it may be a promising complementary method in clinical practice and that it may contribute to reducing unnecessary benign biopsies.

MRI-based breast volumetry-evaluation of three different software solutions

As lipofilling of the female breast is becoming more popular in plastic surgery, the use of MRI to assess breast volume has been employed to control postoperative results. Therefore, we sought to evaluate the accuracy of magnetic resonance imaging (MRI)-based breast volumetry software tools by comparing the measurements of silicone implant augmented breasts with the actual implant volume specified by the manufacturer. MRI-based volume analysis was performed in eight bilaterally augmented patients (46 ± 9 years) with three different software programs (Brainlab© I plan 2.6 neuronavigation software; mass analysis, version 5.3, Medis©; and OsiriX© v.3.0.2. 32-bit). The implant volumes analysed by the BrainLab© software had a mean deviation of 2.2 ± 1.7% (r = 0.99) relative to the implanted prosthesis. OsiriX© software analysis resulted in a mean deviation of 2.8 ± 3.0% (r = 0.99) and the Medis© software had a mean deviation of 3.1 ± 3.0% (r = 0.99). Overall, the volumes of all analysed breast implants correlated very well with the real implant volumes. Processing time was 10 min per breast with each system and 30 s (OsiriX©) to 5 min (BrainLab© and Medis©) per silicone implant. MRI-based volumetry is a powerful tool to calculate both native breast and silicone implant volume in situ. All software solutions performed well and the measurements were close to the actual implant sizes. The use of MRI breast volumetry may be helpful in: (1) planning reconstructive and aesthetic surgery of asymmetric breasts, (2) calculating implant size in patients with missing documentation of a previously implanted device and (3) assessing post-operative results objectively.

Modern breast cancer detection: a technological review

Breast cancer is a serious threat worldwide and is the number two killer of women in the United States. The key to successful management is screening and early detection. What follows is a description of the state of the art in screening and detection for breast cancer as well as a discussion of new and emerging technologies. This paper aims to serve as a starting point for those who are not acquainted with this growing field.

New diagnostic techniques for breast cancer detection

Breast imaging has made huge advances in the last decade, and along with newer techniques to diagnose primary breast cancer, many novel methods are being used and look promising in detecting distant metastasis, recurrent disease and assessing response to treatment. Full-field digital mammography optimizes the lesion–background contrast and gives better sensitivity, and it is possible to see through the dense tissues by altering computer windows; this may be particularly useful in younger women with dense breasts. The need for repeat imaging is reduced, with the added advantage of reduced radiation dose to patients. Computer-aided detection systems may help the radiologist in interpretation of both conventional and digital mammograms. MRI has a role in screening women at high risk for breast cancer. It also aids in cancer management by assessing response to treatment and can help in deciding appropriate surgery by providing accurate information on the extent of the tumor. Newer diagnostic techniques such as sestamibi scans, optical imaging and molecular diagnostic techniques look promising, but need more investigation into their use. Their roles will appear clearer in coming years, and they may prove to be of help in further investigating lesions that are indeterminate on standard imaging. Other upcoming techniques are contrast-enhanced mammography and tomosynthesis. These may give additional information in indeterminate lesions, and when used in screening they aid in reducing recall rates, as shown in recent studies. PET/computed tomography has a role in detecting local disease recurrence and distant metastasis in breast cancer patients.