The choice of the correct imaging modality in breast cancer management

This brief overview discusses which of the diagnostic options are more reliable and effective for breast cancer imaging with a view to avoiding the unjustified use of techniques that are suboptimal. The technological development of diagnostic imaging has been very impressive, and both radiological (mammography, ultrasonography, computed tomography, magnetic resonance imaging) and nuclear medicine tools (bone scan, planar and SPECT scintigraphy, sentinel node biopsy, positron emission tomography) have helped to overcome past limitations in the detection of small lesions. Furthermore, new approaches have been developed that permit successful differential diagnosis of doubtful lesions and rapid identification of systemic metastases, and allow non-invasive characterisation of the biology of cancer tissue. There is evidence that these advances may have helped in optimising therapeutic strategies. Importantly, the metabolic information provided by nuclear medicine procedures may be combined with the anatomical data supplied by radiological techniques in order to assist in predicting tumour response, planning radiotherapy and monitoring patient outcome. It is difficult to formulate conclusive diagnostic guidelines for application in the work-up of breast cancer, because while the role of some examinations, such as mammography and ultrasonography, is well established, that of others, such as magnetic resonance imaging and positron emission tomography, is still a matter of debate. There is a need for further prospective evaluations with appropriate clinical trials designed to evaluate the impact of these approaches in improving survival and quality of life.