[Molecular breast imaging : Positron emission tomography/magnetic resonance imaging and targeted tracers]

Molecular imaging has been introduced into breast imaging in recent years, in order to improve breast cancer (BC) depiction as well as our understanding of cancer-associated processes at a cellular and molecular level.

This review offers an overview of the various molecular imaging modalities implemented in breast imaging as well as of the most significant novel radiotracers and their potential role for the functional evaluation of BC.

The applications and the diagnostic potential of different imaging modalities (scintimammography [SM], breast-specific γ imaging [BSGI], positron emission tomography [PET] mammography [PEM] and PET/MRI) as well as specific tracers (18-fluormisonidazole [¹⁸F‑MISO], 18-fluoro-L-thymidine [¹⁸FLT], 18-fluoroestradiol [¹⁸FES], 89-zirconium-trastuzumab, 18-Fluoroethylcholine [¹⁸FEC] and 68-gallium-fibroblast activation protein inhibitor [⁶⁸Ga-FAPI]) will be discussed.

BSGI increases the sensitivity of SM for small (< 1 cm) lesions, while PEM is more sensitive than whole-body PET scans. Hybrid PET/MRI is the most promising imaging modality for the assessment of BC. While 18F-FDG illustrates the glucose metabolism of cancer cells, novel tracers have other, tumor-specific targets: ¹⁸F‑MISO assesses tumor hypoxia, ¹⁸FLT the metabolism of DNA, ¹⁸FES and ⁸⁹Zr-trastuzumab the tumor receptor status, ¹⁸FEC the metabolism of choline and ⁶⁸Ga-FAPI cancer-associated fibroblasts.

It can be expected that molecular imaging will gain importance for breast imaging in the future, enabling an improved diagnosis, staging, and treatment follow-up.