Molecular Imaging News
December 9, 2005
Breast Cancer Imaging Reviewed
Breast Cancer Research
An editorial by SNM member David Mankoff, MD, introduces a series of articles on breast cancer imaging in the December issue of Breast Cancer Research (BCR). In the editorial Mankoff, associate professor of radiology, medicine, and bioengineering at the University of Washington’s Seattle Cancer Care Alliance, compares today’s clinical and research tools with the state of the art as described in a similar review conducted by BCR in 2000. “Imaging in breast cancer—breast cancer imaging revisited” emphasizes translational research and technologies for earlier breast cancer detection and individualized therapy.
Newer and emerging imaging modalities included in the current review include contrast-enhanced breast MRI, clinical breast MRS, SPECT and PET, and optical imaging, including near infrared imaging, diffuse optical imaging and diffuse optical spectroscopy. Mankoff emphasizes that the newer technologies complement but do not replace the older diagnostic imaging techniques of mammography and CT.
Fusion imaging continues to expand capabilities and offer clinicians more complete information about the disease process. Mankoff writes, “It is increasingly recognized that anatomical imaging and functional imaging work well together; this consideration led to the widespread use of imaging devices with both PET and CT capability (PET/CT).… Preliminary studies show the complementary nature of PET and MRI in assessing response to primary systemic therapy. MRS and PET are also likely to be quite complementary in measuring tumor biochemistry, since MRS measures biochemical pool sizes and PET measures the flux between different biochemical pools.”
The editorial concludes, “Imaging should serve increasingly as a tool for quantifying in vivo tumor biology in both animals and humans and for accelerating the transition from preclinical studies to early clinical trials to routine clinical practice.”
In the accompanying research article “Imaging breast cancer with single photon computed tomography and positron emission tomography,” SNM members Francois Benard, MD, and Eric Turcotte, MD, both of the Centre Hospitalier Universitaire de Sherbrook, Fleurimont, Quebec, Canada, review SPECT and PET applications in breast cancer detection, regional lymph node metastasis detection, distant metastases staging, and therapeutic response assessment for both primary tumors and metastases, noting that primary detection has had only limited clinical use thus far. The rapid advance of FDG PET from research tool to routine clinical management of breast cancer in staging and therapy response is highlighted along with the complementary role that PET plays in improving the diagnostic accuracy of anatomical imaging and PET’s advantages in identifying early response to therapy both in practice and in clinical trials. A discussion of experimental radiotracers, such as those that may predict response to hormonal therapy by targeting estrogen receptors, provides a glimpse into the near-term future of breast cancer imaging.