_{Published November 4, 2022}

On Friday, December 9, the final ARRS Virtual Symposium for 2022, Update on Breast Imaging and Multimodality Biopsy, will address timely topics, including digital breast tomosynthesis (DBT), breast ultrasound (US), breast MRI, molecular breast imaging (MBI), and contrast-enhanced mammography (CEM). Didactic lectures will emphasize the most appropriate biopsy methods and procedures for every one of these aforementioned breast imaging modalities—allowing multiple opportunities for radiologists to improve patient outcomes, using current technologies available for early detection of breast cancer.

Digital Breast Tomosynthesis

I will begin the presentation at noon, Eastern Time, on December 9. Focusing on clinical implementation of DBT, I will review DBT technology and important factors to consider for practical application, such as improved breast cancer detection, synthetic digital mammography, and workflow for screening and diagnostic populations.

Recognizing the need for DBT-guided breast biopsy, Sarah M. Friedewald, MD, of Northwestern University will present on advantages and disadvantages of prone and upright biopsy systems, as well as interpretive outcomes for biopsy-proven, DBT-only findings. Earlier this summer in AJR [1], Dr. Friedewald coauthored the first study of its kind comparing pathologic outcomes between patients with single and multiple architectural distortion visualized by DBT. Ultimately, for those patients with multiple architectural distortions identified on DBT, biopsy of all areas may be warranted, given the variation of pathologic diagnoses.

Breast Ultrasound

Liane Philpotts, MD, of the Yale School of Medicine will describe how to optimize breast US in symptomatic patients, pointing out tools to enhance correlations between sonographic, mammographic, and DBT findings. Additionally, Dr. Philpotts will describe methods for reducing false positives (false negatives, too). Meanwhile, 2004 ARRS Scholar Jessica W. T. Leung, MD, of MD Anderson Cancer Center [2] will help us define the clinical indications, benefits, and limitations of US-guided procedures of the breast, while assessing the post-biopsy imaging/pathologic concordance.

Breast MRI

As recent clinical perspectives have affirmed [3], MRI remains the most sensitive tool for detecting breast cancer; however, cost and acquisition time continue to be deterrents in adopting the technology for routine screening purposes. Following our first question and answer session of the afternoon, fellow InPractice breast imaging contributor [4] Linda Moy, MD, of NYU Langone Health will discuss the present role of screening breast MRI, alongside the roles that AI is poised to play in the very near future. Dr. Moy will also bring everyone up to speed on abbreviated or “ultrafast” MRI protocols for supplemental screening [5]. For her session, Laurie R. Margolies, MD, of Mount Sinai will detail the equipment and techniques required to perform MRI-guided breast biopsy procedures, pointing out both pearls and pitfalls to improve the overall patient experience.

Molecular Breast Imaging and Contrast-Enhanced Mammography

Increasingly, MBI continues its integration into routine breast imaging practice. Haydee Ojeda-Fournier, MD, from University of California San Diego Health will present on this topic, describing the variety of MBI indications for use in clinical practice. Her lecture will incorporate discussions of the MBI lexicon, which is well-timed given that, as AJR acknowledged in July [6], we shouldn’t have to wait too much longer for the American College of Radiology’s BI-RADS committee to initiate its own incorporation of MBI lexicon into the BI-RADS Atlas. Finally, Janice S. Sung, MD, of Memorial Sloan Kettering Cancer Center will deliver a must-see session regarding a relatively new breast imaging modality that is quickly gaining acceptance: CEM [7]. CEM renders density and morphologic information on low-energy images in conjunction with physiologic enhancement via the recombined (i.e., subtracted and processed) images. CEM-guided biopsy is not only FDA-approved, as noted in the most recent issue of InPractice [8], it is frequently necessary for proper patient management. Dr. Sung will detail real-world considerations for setting up a CEM program at your institution and practice, followed by another high-impact question and answer session with the entire faculty.

The experts above continue to enjoy an extensive range of clinical experience with each breast imaging modality presently impacting patient care, so I urge diagnostic radiologists, full-time, or even part-time breast imagers—academic and private practice alike—to join us for Update on Breast Imaging and Multimodality Biopsy on the 9th of December. Offering 4 CME credit hours for ARRS members, the entire program will remain available on demand for practicing radiologists, as well as fellows, residents, and allied medical students, who are unable to attend our live event.  

References

1. Wang LC, Philip M, Bhole S, et al. Pathologic outcomes in single versus multiple areas of architectural distortion on digital breast tomosynthesis. AJR 2022; 1–13:10.2214/AJR.22.27625
2. Scholarship Recipients: Record of ARRS Scholars. ARRS website. ARRS.org/ARRSLIVE/ScholarshipRecipients. Updated February 9, 2022. Accessed October 29, 2022
3. Marshall H, Pham R, Sieck L, Plecha D. Implementing abbreviated MRI screening into a breast imaging practice. AJR 2019; 213: 234–237
4. Moy L. Breast Imaging: One Size Does Not Fit All. ARRS InPractice site. ARRSInPractice.org/breast-imaging-one-size-does-not-fit-all. Published June 22, 2020. Accessed October 29, 2022
5. Mango VL, Grimm LJ, Harvey JA, Plecha DM, Conant EF. Abbreviated Breast MRI for Supplemental Screening: The Why and How of Clinical Implementation. ARRS InPractice site. ARRSInPractice.org/abbreviated-breast-mri-supplemental-screening. Published May 13, 2022. Accessed October 29, 2022
6. Hunt KN, Conners AL, Samreen N, Rhodes DJ, Johnson MP, Hruska CB. PPV of the molecular breast imaging lexicon. AJR 2022; 1–9:10.2214/AJR.21.27047
7. Gandhi J, Phillips J. Contrast-Enhanced Mammography: Current Applications and Future Directions. ARRS InPractice site. ARRSInPractice.org/contrast-enhanced-mammography-current-applications-and-future-directions. Published March 1, 2022. Accessed October 29, 2022
8. Weaver, O. Moving Forward With Contrast-Enhanced Mammography. ARRS InPractice site. ARRSInPractice.org/moving-forward-with-contrast-enhanced-mammography. Published March 1, 2022. Accessed October 29, 2022