Gilbert Fiona J., Pinker-Domenig Katja
Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, UK
Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Breast cancer is the most cause of female cancer deaths in the western world, with early detection of cancer being pivotal for an improved prognosis and survival. Imaging plays a pivotal role in breast cancer detection and staging and helps guiding treatment decisions. Imaging modalities for diagnosis and staging of breast cancer comprise mammography, digital breast tomosynthesis (DBT), ultrasound, contrast-enhanced mammography (CEM), and magnetic resonance imaging (MRI). Mammography is the mainstay of breast cancer screening and diagnosis. Mammography, together with ultrasound and MRI, is used to detect and characterize lesions found at screening and to evaluate symptomatic women. In patients with breast cancer, mammography, often in conjunction with specialized views, can determine lesion size and location and assess the surrounding tissue and lymph nodes. DBT is a three-dimensional (3D) imaging method with the potential to overcome the main limitation of standard two-dimensional mammography, a masking effect due to overlapping fibroglandular breast tissue, improving diagnostic accuracy in breast cancer, particularly in dense breasts. CEM allows both a morphologic evaluation comparable to routine digital mammography and through contrast agent application a simultaneous assessment of tumor neovascularity as an indicator of malignancy similar to MRI. Data indicate that CEM has an improved sensitivity and increases the specificity compared with mammography. Breast US is widely used to confirm a diagnosis of cancer, to look for additional disease in the breast, for image-guided breast biopsy and localization, assessment of the axilla, and as a second-look tool in patients with abnormalities found on MRI. MRI of the breast is the most sensitive modality for breast cancer detection. MRI of the breast is used for the assessment of disease extent and detection of additional lesion and seems to be more useful than mammography when staging multifocal and multicentric disease or when DCIS is present. This chapters will provide an overview of when and how to use mammography, DBT, ultrasound, CEM, and MRI for diagnosis and staging of breast cancer.
在西方世界，乳腺癌是导致女性癌症死亡的主要原因，早期发现癌症对于改善预后和生存率至关重要。影像学在乳腺癌的检测和分期中起着关键作用，并有助于指导治疗决策。用于乳腺癌诊断和分期的影像学检查方法包括乳腺X线摄影、数字乳腺断层合成（DBT）、超声、对比增强乳腺X线摄影（CEM）和磁共振成像（MRI）。乳腺X线摄影是乳腺癌筛查和诊断的主要手段。乳腺X线摄影与超声和MRI一起，用于检测和表征筛查中发现的病变，并评估有症状的女性。在乳腺癌患者中，乳腺X线摄影通常结合特殊视图，可以确定病变的大小和位置，并评估周围组织和淋巴结。DBT是一种三维（3D）成像方法，有可能克服标准二维乳腺X线摄影的主要局限性，即由于乳腺纤维腺组织重叠导致的掩盖效应，提高乳腺癌的诊断准确性，特别是在致密型乳腺中。CEM既可以进行与常规数字乳腺X线摄影相当的形态学评估，又可以通过应用造影剂同时评估肿瘤新生血管，作为类似于MRI的恶性肿瘤指标。数据表明，与乳腺X线摄影相比，CEM具有更高的敏感性并提高了特异性。乳腺超声广泛用于确诊癌症、寻找乳腺中的其他疾病、进行图像引导的乳腺活检和定位、评估腋窝，以及作为MRI检查发现异常的患者的二次检查工具。乳腺MRI是检测乳腺癌最敏感的检查方法。乳腺MRI用于评估疾病范围和检测其他病变，在对多灶性和多中心性疾病进行分期或存在导管原位癌（DCIS）时，似乎比乳腺X线摄影更有用。本章将概述何时以及如何使用乳腺X线摄影、DBT、超声、CEM和MRI进行乳腺癌的诊断和分期。
