Breast imaging remained a strong point of scientific research at the 2008 RSNA meeting, with breast MRI playing a starring role but sharing the limelight with tomosynthesis, position emission mammography, and breastspecific gamma imaging.
Nola Hylton, Ph.D., and colleagues showed preliminary results from American College of Radiology Imaging Network trial 6657. It found that MRI measures residual breast cancer disease more accurately than clinical exams or mammography. Hylton, a professor of radiology at the University of California, San Francisco, and colleagues examined 216 breast cancer patients at eight institutions. The measures helped predict the breast tumors' response to neoadjuvant chemotherapy.
Women with invasive breast cancer measuring 3 cm or greater who received an anthracycline-cyclophosphamide (AC) neoadjuvant chemotherapy regimen followed by a taxane regimen were enrolled between May 2002 and March 2006. Contrast-enhanced MRI was performed at baseline, following one AC cycle, between AC and taxane treatment, and after taxane treatment but prior to surgery.
Following neoadjuvant chemotherapy, MRI is more accurate than clinical exams or mammography for estimating residual disease and predicting response to treatment, said Hylton, director of the Magnetic Resonance Science Center at UCSF.
Not only did the ACRIN trial use breast MRI, but a study out of Ohio demonstrates the modality can have a positive impact on clinical decision making for black women with newly diagnosed breast cancer.
Few studies have addressed if and how breast MRI affects how black women make clinical decisions, said Dr. Laura Shepardson, a radiologist at The Cleveland Clinic.
A total of 306 African American patients had a breast MR exam at The Cleveland Clinic between 2003 and 2007. Of these, 111 (36%) with newly diagnosed ductal carcinoma in situ, invasive ductal carcinoma, or invasive lobular carcinoma were included in Shepardson's study. The women in the study had no prior history of radiotherapy or chemotherapy.
The treatment was breast conservation in 58% of cases (64 women) and mastectomy in 42% (47). Radiotherapy was performed in 64% of cases (71 women), chemotherapy in 48% (53), and endocrine therapy in 43% (48). In 13% of cases (14 women), the MR exam prompted a negative secondlook ultrasound and/or negative biopsy. These false-positive findings may partly reflect a learning curve for the interpreting radiologists.
Breast MRI dominated breast research, but other modalities, like breast tomosynthesis, also made an appearance.
Breast tomosynthesis detects lesions with even greater sensitivity than breast MRI, which may also be its downfall, according to one researcher.
