Which Modality is More Effective for Diagnosing Breast Cancer?
Mammography is the most common method used to screen for breast cancer. However, it has limitations, especially in detecting disease in thick breast tissue. To overcome these limitations, ultrasonography is often used as an alternative screening tool. But is there a more effective modality?
Contrast-enhanced mammography (CEM) and dynamic contrast-enhanced breast magnetic resonance imaging (MRI) are two modalities that have been explored. According to an article published in Radiologic Clinics, the effectiveness of these modalities depends on various factors.
CEM, although slightly less effective than MRI, can be a viable alternative in many situations. It was approved by the FDA as an auxiliary modality for follow-up diagnostic testing for breast cancer. However, it has not been approved for screening purposes.
On the other hand, breast MRI has been available since 1984 and has shown high specificity and sensitivity in detecting breast cancer. It is particularly recommended for high-risk patients, such as carriers of the BRCA gene mutation.
One of the advantages of MRI is its ability to visualize regions that are difficult to identify on mammography, such as the axilla and far posterior locations. However, the cost of MRI is significantly higher, and insurance coverage may not always be available.
In terms of imaging time, CEM takes longer to obtain images of certain breast regions compared to MRI. Additionally, MRI is useful for assessing the integrity of breast implants and for evaluating chemotherapy response.
When choosing between these modalities, several factors should be considered. These include the likelihood of strong background parenchymal enhancement (better managed with MRI), the importance of radiation exposure (relevant for young women), equipment availability, and patient preferences (e.g., claustrophobia).
In conclusion, both CEM and MRI have their advantages and limitations in diagnosing breast cancer. The choice of modality depends on various factors, and it is important to consider the individual patient’s needs and circumstances. Ultimately, the goal is to detect breast cancer accurately and effectively, ensuring the best possible outcomes for patients.