Molecular Imaging of the Breast

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Molecular subtypes of breast cancer

Technologies allowing the simultaneous determination of expression from several thousand genes in tumor tissue have profoundly changed breast cancer treatment and research. These technologies are based on arrays of oligonucleotides to which tissue RNA or DNA is hybridized.3, 4, 5, 6 Expression arrays are designed to determine the amount of tumor RNA for any gene on the array that is expressed in the tumor. Expression arrays are available commercially from several vendors. Because these arrays

Imaging breast cancer phenotypes

Are there recognizable phenotypic differences between, for example, an ER-positive tumor and a triple-negative tumor that result in unique MR appearances that could in some way predict treatment outcome? Phenotypes are those observable characteristics of an organism caused by the gene expression pattern; phenotype is the result of the genotype and the history and current condition of an organism’s developmental environment. Tchou and colleagues13 found observable differences specific to

Proton MRS

MRS is perhaps the most established of the molecular imaging techniques, and for this reason, this method is discussed in detail. MRS has been used since the late 1980s to investigate tumor development and progression in cells and biopsies. Proton (1H) MRS can identify pathology in human tissues with a high level of accuracy.15, 16 The MRS method shows the chemical composition of cells and those changes that occur with tumor development and progression.17 MRS also can identify some

Other advanced applications of MRI

A modification of contrast-enhanced MRI is dynamic contrast-enhanced MRI, so-called DCE, where temporal resolution is emphasized at the expense of spatial resolution. This modified protocol collects information from more than the three or four standard postcontrast injection time points and, using mathematic equations, fits the data to pharmacokinetic models to assess physiologic parameters including tissue perfusion, microvascular vessel wall permeability, extracellular volume fraction, and

Computed tomography

Development and testing of computed tomography (CT) systems for dedicated breast CT offer the advantage of isotropic three-dimensional anatomic detail while limiting the obscuring of abnormalities by overlying tissue.48 Lindfors and colleagues49 reported the overall performance of CT to be equal to that of mammography, with differences in the visualization of masses (CT superior) and calcifications (mammography superior) (Fig. 8). Only 4 of their 69 patients received iodinated contrast

Nuclear medicine techniques

Sestamibi imaging using 99mTc-MIBI and PET using 18F-FDG identify tumors because of sequestering radionuclide within cells. In the case of the MIBI isotope, there is specific mitochondrial uptake with as much as nine times greater uptake within tumor cells as compared with normal cells. FDG PET is based on normal glucose metabolism, with intracellular phosphorylation trapping the ion within the cell as FDG-6-phosphate. The FDG ion is an example of one of the two molecular imaging probe types,

Optical imaging

Optical imaging of the breast combines functional and molecular characteristics of disease using near-infrared light. Research methods include use of intrinsic tissue contrast and exogenous fluorescent probes. These activation-capable probes provide information pertinent to physiologic and molecularly controlled variables related, in particular, to angiogenesis and hypoxia55, 56 and show potential for preclinical imaging and drug discovery (see Fig. 9).57 Conklin and colleagues58 reported

The Horizon

Recognition of the importance of personal factors, such as the risk for development of breast cancer, is likely to alter the current screening imaging paradigms and many believe that health care providers are

“Likely to transition from a standardized screening, where all women undergo the same imaging examination (mammography), to selection of a screening modality or modalities based on individual risk or other classification”60

Hopefully the recognition that one size may indeed not fit all may

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  • Cited by (6)

    This article is republished from Birdwell RL, Mountford CE, Iglehart JD. Molecular imaging of the breast. Am J Roentgenol 2009;193:367–76; with permission.

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