In addition to women with dense breasts, there are also other women for whom mammographic screening is not really enough, which is why research needs to continue in this field. Dr. Wendie Berg, a leading breast cancer specialist, talks with ITN about new research and advancements in breast imaging technology.

Dr. Berg, MD, PhD, FACR, FSBI, is Professor of Radiology at the University of Pittsburgh School of Medicine and Magee-Womens Hospital of UPMC, specializing in breast imaging. She is also the Chief Scientific Advisor to DenseBreast-info.org. A renowned expert, she writes and co-edits one of the leading textbooks on the topic, Diagnostic Imaging: Breast, currently in its third edition, and has co-authored over 120 peer-reviewed research publications.

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Dr. Frank A. Vicini, MD, FACR, FASTRO, FABS, who is a radiation oncologist with GenesisCare, discussed his findings from a phase III trial presented at ASTRO22 that evaluated new and improved techniques to treat patients with breast cancer. Here he shares some of his findings with Imaging Technology News (ITN). 

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Constance "Connie" Lehman, M.D., Ph.D., chief of breast imaging, co-director of the Avon Comprehensive Breast Evaluation Center at the Massachusetts General Hospital, and professor of radiology at Harvard Medical School, explains issues and suggested guidelines for women who receive the COVID-19 vaccine and need to get a mammogram. In the first three months since the vaccines have been released, there have been numerous case reports of the vaccine causing swollen lymph nodes. This is would usually raise a red flag for breast cancer, but is normal for many women receiving the vaccine as their body's immune system gears up against the virus. 

Lehman said cases reports of axillary adenopathy have been identified on breast imaging after coronavirus disease (COVID-19) vaccination and are rising. Lehman et al. proposed a pragmatic management approach in a recent article in the American Journal of Roentgenology (AJR).[1]

In the settings of screening mammography, screening MRI and diagnostic imaging work-up of breast symptoms, with no imaging findings beyond unilateral axillary adenopathy ipsilateral to recent (prior six weeks) vaccination, they report the adenopathy as benign with no further imaging indicated if no nodes are palpable six weeks after the last vaccine dose. 

For patients with palpable axillary adenopathy in the setting of ipsilateral recent vaccination, clinical follow-up of the axilla is recommended. In all these scenarios, axillary ultrasound is recommended if clinical concern persists six weeks after vaccination. 

In patients with recent breast cancer diagnosis in the pre- or peri-treatment setting, prompt recommended imaging is encouraged as well as vaccination (in the thigh or contralateral arm). The recommendations align with the ACR BI-RADS Atlas and aim to: 1) reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccination, and 2) avoid further delays in vaccinations and breast cancer screening during the pandemic.

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Reference:

1. Constance D. Lehman, Leslie R. Lamb, and Helen Anne D'Alessandro. Mitigating the Impact of Coronavirus Disease (COVID-19) Vaccinations on Patients Undergoing Breast Imaging Examinations: A Pragmatic Approach American Journal of Roentgenology. 10.2214/AJR.21.25688

Professor Christiane Kuhl, M.D., director of radiology, University Hospital Aachen, Germany, explains how breast magnetic resonance imaging (MRI) can be used to clearly identify breast cancers in women with dense breast tissue. In women with dense breasts, it can be very difficult to detect many cancers on standard mammograms because the cancers and dense tissue both appear white. MRI can help clearly define tumors and identify which nodules are cancer and which are benign, which can help greatly reduce the need for biopsies.

Kuhl is an expert in breast imaging and breast MRI. She helped develop an a shortened MRI protocol that allows breast MR images to be created in 3 minutes or less, rather than standard protocols that can take up to 30 minutes. In the interview she shows patient case examples of standard mammograms and the MRI supplemental imaging for the same patient to show the hidden tumors. 

She also explains the differences between standard 2-d mammography, the current standard of care, and the newer 3-D mammogram tomosythnesis technology, breast ultrasound and breast MRI technologies.

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Professor Christiane Kuhl, M.D., director of radiology, University Hospital Aachen, Germany, explains what it means to have dense breasts and how density can hide cancers in mammograms. She offers an explanation describing dense breast tissue and that this occurs in about half of women. Density is itself a risk factor for breast cancer and the fact that dense tissue hides cancers on mammography means that supplemental imaging is needed to accurately diagnose these patients and avoid false positives, or needless tissue biopsies. Breast ultrasound and breast magnetic resonance imaging (MRI) can be used to see through dense tissue to better identify cancers and avoid the need for many biopsies.

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VIDEO: Use of Breast MRI Screening in Women With Dense Breasts

VIDEO: The Impact of COVID-19 on Breast Imaging

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Imaging Technology News Contributing Editor Greg Freiherr interviewed Henry Izawa, vice president of modality solutions, Fujifilm Medical Systems U.S.A., Inc. about Fujifilm's latest innovations in mammography.

In this video, Izawa announces the latest imaging advancements available for the Aspire Cristalle digital mammography system with digital breast tomosynthesis, including S-View, a synthesized 2-D image reconstructed from DBT and other patient enhancements such as the comfort paddle to provide a noticeably more comfortable exam for the patient.

Watch the video to hear all about Fujifilm's updates.

To learn more, visit www.fujimed.com

At RSNA19, David Widmann, president and CEO of Konica Minolta Healthcare Americas, discussed innovation, stressing the importance of academic relationships. 

Wendie Berg, M.D., Ph.D., FACR, chief scientific advisor to DenseBreast-info.org and professor of radiology at University of Pittsburgh School of Medicine/Magee-Women’s Hospital of UPMC, spoke with ITN Editorial Director Melinda Taschetta-Millane about some of the proposed amendments to the language being used for mammography reporting and quality improvement.

Read the article "FDA Proposes New Rules for Mammography Reporting and Quality Improvement"

Magid Awadalla, MBBS, is an advanced cardiac imaging research fellow at Massachusetts General Hospital. He has been involved in an imaging study of cardiac changes from photon radiotherapy in breast cancer patients using serial cardiac magnetic resonance imaging (MRI). The radiotherapy beams used to treat breast cancer pass close to the neighboring heart, which can cause cardiac cell damage leading to issues like heart failure later on. He spoke on the topic of cardio-oncology at the American College of Cardiology (ACC) 2019 meeting.

Supplemental screening with ABUS helps personalize breast care for women with dense breasts and offers advanced clinical confidence for radiologists. ABUS can play an important role in early diagnosis of small, node negative, invasive cancers. Hear from Georgia Giakoumis Spear, M.D., from NorthShore University HealthSystem in the Chicagoland Area of Illinois as she speaks with Lucas Delaney, general manager for ABUS at GE Healthcare. As an early adopter of ABUS, she discusses the clinical need and her results with ABUS. She also provides her impressions of the newly introduced Invenia ABUS 2.0, and demonstrates a case utilizing the coronal view.

See GE Healthcare Introduces Invenia ABUS 2.0.

An interview with A. M. Niser Syed, M.D., medical director, radiation oncology and endocurietherapy, MemorialCare Cancer Institute, Long Beach, Calif. At the American Society for Radiotherapy and Oncology (ASTRO) 2018 annual meeting, he presented a study of 1,200 patients using a single session of intra-operative radiation therapy (IORT) using the Xoft X-ray emitting brachytherapy system. 

ITN Associate Editor Jeff Zagoudis speaks with Karen Hou, M.D., breast radiologist at Northwestern Medicine Central DuPage Hospital in Winfield, Ill., about the hospital's use of new technology and innovative practices. Read more about the clinic the article "High-Risk Clinic Arms Patients Against Breast Cancer."

See more content from ITN's visit to Northwestern Medicine Central DuPage Hospital.

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Fujifilm details its latest innovations in women's health including its ASPIRE Cristalle mammography system with digital breast tomosynthesis software option and its Synapse 5 PACS and VNA, enabling secure, easy-to-manage storage and access to the complete patient imaging record throughout the healthcare enterprise.

Martin Yaffe, Ph.D., FAAPM, senior scientist, physical sciences/imaging research, Sunnybrook Health Sciences Centre, and professor of medical biophysics and medical imaging, University of Toronto, discusses how contrast-enhanced mammography can improve breast cancer detection at the 2017 Radiological Society of North America (RSNA) meeting.

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William Hall, M.D., radiation oncologist in the Department of Radiation Oncology at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., discusses study results presented at theAmerican Society of Radiation Oncology (ASTRO) 2016. Video courtesy of Dr. Hall. You can read Dr. Hall's article on this topic, Breast Cancer Radiation Planning, here. 

Monica Saini, M.D., consultant medical director — ABUS at GE Healthcare, discusses the necessity for personalized breast care, and how Automated Breast Ultrasound (ABUS) helps meet the challenges of screening and diagnostic imaging of dense breast tissue. To learn more about Automated Breast Ultrasound, please visit gehealthcare.com/inveniaabus.

Interview with Gerald Kolb, JD, president of The Breast Group in Bend, Ore. Kolb spoke at the 2016 AHRA meeting in Nashville about the challenges of multimodality breast screening, the need for more personalized screening programs and the impact of recent screening recommendations. Read about the lastest advances in breast imaging.

Ernie Bodai, M.D., vice president, National Consortium of Breast Centers (NCBC), discusses breast density with itnTV. Read an article with related links about breast density.

Barbara Rabinowitz, Ph.D., MSW, RN, founder of the National Consortium of Breast Centers, talks with ITN editorial director Melinda Taschetta-Millane during NCoBC's 26th annual conference, and addresses the very important topic of survivorship.

Jennifer Gass, M.D., FACS, president, National Consortium of Breast Centers (NCBC), discusses the state of the breast imaging industry.