Breast Radiology Session

Thank you to everyone for joining us at our most recent session. Please see summary below of papers discussed

Minimally Invasive Treatment for Early-Stage Breast Cancer

Recent advancements in early breast cancer detection have allowed clinicians to identify smaller tumors with favorable outcomes, leading to questions about the necessity of conventional, invasive treatments. Traditional methods, such as surgery and adjuvant therapy, often place physical and emotional strain on patients, particularly for low-risk cases. Newer, minimally invasive techniques—namely vacuum-assisted excision (VAE), cryoablation, and radiofrequency ablation (RFA)—are showing promise in reducing treatment burdens and lowering healthcare costs.

• Vacuum-Assisted Excision (VAE): VAE is a modified version of vacuum-assisted biopsy, using a larger needle to remove multiple tissue samples in a single pass. It is particularly effective for diagnosing and managing benign and low-risk lesions. VAE requires only local anesthesia and imaging guidance, offering a shorter recovery time and fewer aesthetic concerns than surgical options. Clinical studies report a 93% success rate in completely excising benign lesions with VAE. However, side effects like bruising, pain, and minor hematomas may still occur.
• Cryoablation and Radiofrequency Ablation (RFA): Cryoablation involves applying extreme cold to destroy cancerous cells. In under 45 minutes, the procedure can be completed with minimal local anesthesia due to the numbing effect of cold temperatures. Common side effects include mild breast pain, bruising, and skin irritation, but recovery is generally fast and non-disruptive. RFA, on the other hand, employs heat through low-frequency radio waves to selectively destroy cancer cells while sparing healthy tissue. Both procedures are recommended for small, low-risk tumors, and clinical outcomes show low recurrence rates and high disease-free survival for these techniques. For patients, these minimally invasive options mean reduced physical burden, minimized recovery time, and potentially fewer financial costs compared to more invasive surgical approaches.

Screening Contrast-Enhanced Mammography for Dense Breast Tissue

Dense breast tissue poses challenges for cancer detection due to similar imaging appearances of dense tissue and tumors on mammograms, both appearing as white. Contrast-enhanced mammography (CEM) has gained attention as a viable alternative for detecting cancers that traditional mammography might miss, particularly in women with dense breast tissue. By using iodinated contrast, CEM allows for more accurate imaging, revealing tumors through enhanced visibility.

• Study Findings: In a large retrospective study conducted on asymptomatic women with dense breast tissue, CEM significantly improved cancer detection, capturing an additional 11 cases missed by traditional low-energy (LE) mammography. CEM’s sensitivity reached 88.9%, much higher than the 27.8% sensitivity of standard LE mammography, albeit with slightly reduced specificity. These findings suggest that CEM may allow for earlier cancer detection in patients with extremely dense breast tissue, where conventional methods have reduced accuracy.
• Benefits and Limitations: CEM demonstrates strong potential as a supplemental screening tool. Its advantages include accessibility, lower costs, and improved detection rates similar to MRI, but at a lower cost and reduced procedure time. However, limitations exist, including a higher radiation dose compared to standard mammography and the potential risks of iodinated contrast, which may pose risks of nephropathy or allergic reactions. Despite these considerations, the benefits of CEM in improving early cancer detection rates for high-density breast tissue are notable, though further large-scale trials are needed to establish CEM’s role in routine screenings.

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