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Advances in breast imaging and the integration of new technologies into diagnostic procedures were the topics of Constance Lehman’s presentation at the San Antonio Breast Cancer Symposium (SABCS) in December.

Lehman, Professor of Radiology at Harvard Medical School, emphasized that the technical possibilities of breast cancer diagnostics have greatly improved, particularly through advances in mammography, ultrasound, and magnetic resonance imaging (MRI). However, practical implementation is lagging, particularly concerning targeted application in certain risk groups, such as women with dense breasts or an increased risk of cancer.

3D tomosynthesis

Lehman began by highlighting the evolution of imaging technologies, from the early approaches to mammography to modern 3D tomosynthesis and contrast-enhanced mammography. 3D tomosynthesis is now considered the standard in the US, while other countries such as Canada and many European countries continue to rely on 2D mammography. “This technology allows a detailed view of tissue overlays and improves the ability to detect suspicious changes,” says the professor.

According to Lehman, one risk factor is breast density. “Women with heterogeneously dense or extremely dense breasts have a higher risk of a tumor being missed during a standard mammogram,” the expert made clear. The American College of Radiology (ACR) therefore recommends using MRI as a complementary procedure in such cases. At the same time, however, the ACR also points out that molecular breast imaging is not practical in screening programs due to cost, accessibility, and radiation exposure, even though it provides valuable diagnostic information.

Automated breast ultrasound (ABUS)

Lehman explained that ultrasound, in particular automated breast ultrasound (ABUS), offers advantages over manual ultrasound as it is less time-consuming and enables standardized 3D volume images. “Nevertheless, the detection rate of additional tumors remains lower than MRI, limiting its application to specific diagnostic scenarios.

Contrast-enhanced mammography (CEM)

Lehman highlighted contrast-enhanced mammography (CEM) as a promising alternative to MRI. It combines the advantages of mammography with contrast-enhanced imaging of vessels and tumors. Lehman: “Studies show that the sensitivity and specificity of CEM is comparable to that of MRI, but with significantly lower costs and better accessibility.” The radiologist called for greater integration of this method into clinical practice but pointed out existing challenges, such as insufficient reimbursement.

The use of modern AI technologies in breast cancer diagnostics is also promising, particularly in the autonomous analysis of mammograms. Automation could make screening processes more globally accessible and at the same time more precise. This would improve diagnostic accuracy, reduce costs, and increase efficiency. “AI could be a key to reducing the current variability in image interpretation,” summarized Lehman. 

Demand: revision of existing risk models

She concluded by calling for a revision of existing risk models and screening approaches. “Instead of relying solely on breast density as a risk factor, more comprehensive and precise models should be developed to better identify target groups and make more efficient use of the technologies used,” she said. She was optimistic that the combination of technological advances, AI, and targeted screening strategies could revolutionize breast cancer diagnostics. This would not only improve survival rates but also significantly increase patients’ quality of life.