IMAGING OF THE BREAST – TECHNICAL ASPECTS AND CLINICAL IMPLICATION Edited by Laszlo Tabar Imaging of the Breast – Technical Aspects and Clinical Implication Edited by Laszlo Tabar Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Bojan Rafaj Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Imaging of the Breast – Technical Aspects and Clinical Implication, Edited by Laszlo Tabar p. cm. ISBN 978-953-51-0284-7 Contents Preface IX Part 1 New, Innovative Breast Imaging Modalities 1 Chapter 1 Magnetic Resonance Imaging of the Breast 3 Marc Lobbes and Carla Boetes Chapter 2 The Application of Breast MRI on Asian Women (Dense Breast Pattern) 17 Ting Kai Leung Chapter 3 Scintimammography - Molecular Imaging: Value and New Perspectives with 99m Tc(V)-DMSA 61 Vassilios Papantoniou, Pipitsa Valsamaki and Spyridon Tsiouris Chapter 4 Digital Mammography 81 Cherie M. Kuzmiak Chapter 5 Image Quality Requirements for Digital Mammography in Breast Cancer Screening 115 Margarita Chevalier, Fernando Leyton, Maria Nogueira Tavares, Marcio Oliveira, Teogenes A. da Silva and João Emilio Peixoto Chapter 6 Contrast Enhancement in Mammography Imaging Including K Edge Filtering 133 George Zentai Chapter 7 Standards for Electrical Impedance Mammography 159 Marina Korotkova and Alexander Karpov Chapter 8 The Role of Molecular Imaging Technologies in Breast Cancer Diagnosis and Management 179 Anne Rosenberg, Douglas Arthur Kieper, Mark B. Williams, Nathalie Johnson and Leora Lanzkowsky VI Contents Part 2 Clinical Implications 197 Chapter 9 Suspicious Nipple Discharge Diagnostic Evaluation 199 Yukiko Tokuda and Yoshinori Kodama Chapter 10 Radiotherapy After Surgery for Small Breast Cancers of Stellate Appearance 217 Laszlo Tabar, Nadja Lindhe, Amy M.F. Yen, Tony H.H. Chen, Sherry Y.H. Chiu, Jean C.Y. Fann, Sam L.S. Chen, Grace H.M. Wu, Rex C.C. Huang, Judith Offman, Fiona A. Dungey, Wendy Y.Y. Wu, Robert A. Smith and Stephen W. Duffy Preface Early detection of breast cancer combined with targeted therapy offers the best outcome for breast cancer patients. The development of low-dose screen-film mammography made the early detection of breast cancer a reality. This technology was successfully implemented in the population-based screening trials, which proved that the early detection of breast cancer through mammography screening can prevent at least 40% of the deaths from breast cancer in participating women. Additionally, these smaller and less advanced cancers do not need as extensive therapy as the larger, palpable cancers. The heterogeneity of benign and malignant breast diseases has necessitated the development of supplementary imaging methods for their improved detection and differential diagnosis. The optimum preoperative diagnosis and mapping of the full disease extent has become an important prerequisite for adequate management of the disease. This volume deal with a wide range of new technical innovations for improving breast cancer detection, diagnosis and therapy. There is a special focus on improvements in mammographic image quality, image analysis, magnetic resonance imaging of the breast and molecular imaging. A chapter on targeted therapy explores the option of less radical postoperative therapy for women with early, screen-detected breast cancers. Laszlo Tabar, M.D., F.A.C.R. Department of Mammography Falun Central Hospital Falun, Sweden [...]... inform the patient that lying comfortly and motionless is important for succesfull imaging of the breast They should be instructed that administration of the contrast agent can result in various physical sensations, which may cause patient anxiety (and motion) when not properly instructed 4 Imaging of the Breast – Technical Aspects and Clinical Implication A dedicated breast coil should be used for breast. .. of diagnostic problems Proper indications for performing breast MRI (as supported by the European Society of Breast Cancer Specialists and the European Society of Breast Imaging) are: inconclusive findings in conventional imaging, preoperative staging, unknown primary cancer, evaluation of therapy response in neoadjuvant chemotherapy, imaging of the breast after conservative therapy, screening of the. .. biopsy 10 Imaging of the Breast – Technical Aspects and Clinical Implication However, both studies have some limitations For example, the COMICE trial recruited patients from 45 centres, resulting in a large variation of radiologic experience when evaluating the breast MRI exams The MONET trial only evaluated non-palpable breast tumors and a subanalysis of their results showed that the volume of the lumpectomy... United States, Canada, Italy, and Germany, the American Cancer Society (ACS) and European Society of Breast Imaging (EUSOBI) recommended annual MR evaluation of the breasts for 12 Imaging of the Breast – Technical Aspects and Clinical Implication all women with a lifetime risk for breast cancer of more than 20-25% (Saslow et al., 2007, Mann et al., 2008) These women include known BRCA gene mutation... Despite the considerably smaller proportion of non-dense areas, the overall proportion of dense breast tissue in the breasts of Chinese and Japanese women is 20 % higher than in Caucasian women in the same age group (Huang et al., 2001; Maskarineca et al., 2001) Irrespective of race, women with lower mammographic densities have a lower risk of breast cancer 26 Imaging of the Breast – Technical Aspects and. .. lesions in magnetic resonance imaging of the breast: additional T2-weighted images improve diagnostic accuracy J Comput Assist Tomogr Vol 35, No 3, May/June 2011, pp 361- 366 20 Imaging of the Breast – Technical Aspects and Clinical Implication Berg et al (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer Radiology Vol 233,... al., 2009) By 2009, there is still no significant survival benefit could be demonstrated in the country, in the meanwhile, rapid increase of breast cancer incidence was reported Singapore government choose for longer period of 24 Imaging of the Breast – Technical Aspects and Clinical Implication follow-up, expect for the benefit of mortality reduction in the population resulted from their mass mammography... this might influence breast perfusion, and thus contrast enhancement pharmacokinetics In premenopausal women, the enhancement of the fibroglandular tissue after contrast administration is dependent of the menstrual cycle MR imaging of the breast in the wrong phase of the menstrual cycle can result in strong glandular enhancement, complicating the interpretation of the images Elective breast MRI is ideally... months after the last irradiation of the breast Nonetheless, Morakkabati et al demonstrated that the detection and characterization of breast lesions can be performed with comparible diagnostic accuracies in irradiated breasts (when compared with nonirradiated breasts, Morakkabati et al., 2003) Finally, the risk of local recurrence is dependent on the age of the patient at the time of the diagnosis... New, Innovative Breast Imaging Modalities 1 Magnetic Resonance Imaging of the Breast Marc Lobbes and Carla Boetes Maastricht University Medical Center The Netherlands 1 Introduction Magnetic resonance imaging (MRI) of the breast was first performed in the late 1980s At first, differentiation between benign and malignant breast lesions was primarily based on their differences in T1 and T2 relaxations . IMAGING OF THE BREAST – TECHNICAL ASPECTS AND CLINICAL IMPLICATION Edited by Laszlo Tabar Imaging of the Breast – Technical Aspects and Clinical Implication Edited. properly instructed. Imaging of the Breast – Technical Aspects and Clinical Implication 4 A dedicated breast coil should be used for breast MRI. These coils usually consist of a multichannel. by Yau et al., who reviewed Imaging of the Breast – Technical Aspects and Clinical Implication 8 3001 MRI exams and found 204 MRI exams that were performed for ‘problem solving’. Of these