1. To discuss the relevance and application of tomosynthesis in breast imaging.
2. To understand the indications and use of breast MRI in pre-menopausal women.
3. To appreciate the current debate regarding the appropriateness of breast screening programmes.
Tomosynthesis is a relatively new modality in digital mammography that increases conspicuity if lesions that are hidden by superposition of breast parenchyma. Also, MRI is established diagnostic modality for numerous indications: for high-risk screening, detection of residual lesions or recurrence after surgery, for the detection of breast cancer when axillary lymph nodes are positive and mammography and ultrasound negative, and for monitoring of neoadjuvant treatment, and in some cases for preoperative evaluation of the extent of cancer. Breast cancer screening is a matter of many controversies, in the light of overdiagnosis and overtreatment, but it is generally accepted that biannual mammographic screening should be offered to healthy women of the age group of 50-69. Supplemental screening with ultrasound and tomosynthesis is indicated in many cases of dense breasts, and a special regimen should be applied to women with a high risk of acquiring breast cancer.
1. To review the technology underpinning tomosynthesis.
2. To understand the current evidence base for use of tomosynthesis.
3. To appreciate results from the UK TOMMY trial and others.
The aim of the presentation is to provide a basic introduction to digital breast tomosynthesis (DBT) and the principles that underpin this technique. An overview in general of the current evidence to support the use of DBT in clinical practice. A discussion of the impact of DBT in terms of mammographic practice to include technique and positioning.
1. To understand current sensitivity of MRI when imaging the breast.
2. To discuss the varying sensitivities of mammography and ultrasound according to age.
3. To appreciate the potential use of abbreviated MRI sequences.
Nowadays, Magnetic Resonance Imaging (MRI) is used routinely to provide anatomic details and contrast while, allows the evaluation of the functionality of the organ, the quantification of the lesions and histological information. Although breast cancer in young women is relatively uncommon, affecting about 4-6% of women under the age of 40 and less than 4% are diagnosed under the age of 35, there has been an increase in the number of breast cancers diagnosed in the premenopausal women. The first indication to Breast MRI from EUSOBI is the screening of women at high risk of breast cancer; however, diagnosing breast cancer in women under 40 years old is more difficult as their breast tissue is, generally, denser. There have been significant advances in technical developments and clinical applications with the goal to improve image acquisition, early cancer diagnosis, treatment monitoring, the prognostic indication and predictive biomarkers. The discussion is centred on the new acquisition techniques to improve cancer detection specificity in premenopausal women and the comparatively to mammography and ultrasound. The limitations of the technique and, in the other hand, the technology improvements like technical developments on advanced quantitative MRI, the breast MRI in clinical trials, the fast techniques, updates on DWI, perfusion, novel contrasts, spectroscopy and the impact of artificial intelligence on breast MRI research and clinic, will be addressed. We cannot forget the strategies to increase the early prevention, regarding the appliance of best practices around the world and incorporating the psychosocial concerns of the disease.
1. To identify advantages and disadvantages of breast screening regarding false positives.
2. To appreciate current debate both for and against organised screening programmes.
3. To consider alternatives to breast screening.