Assessing suspicious breast lesions

The clinical dilemma: Maximizing sensitivity while increasing specificity

Breast cancer is the most prevalent cancer in women. Currently, X-ray, ultrasound and MRI are used for identifying suspicious lesions. X-ray mammography is used in screening programs, while ultrasound and MRI are typically used for follow-up assessment of suspicious lesions. A biopsy is often performed to confirm malignancy.

Despite the availability of such a broad diagnostic imaging arsenal, the established modalities suffer from shortcomings. While X-ray has a low sensitivity resulting in false negative rates as high as 20 percent, particularly in dense breast tissue, ultrasound and MRI are limited with regards to specificity, resulting in a high number of negative biopsies. Therefore, there is an urgent need for alternative imaging approaches with improved sensitivity and specificity for breast cancer diagnosis.

Initial clinical trials suggest that MSOT can help address this clinical dilemma

Recent clinical studies suggest that optoacoustic imaging could potentially fill this gap by providing additional anatomical and functional tissue information to distinguish benign from malignant breast lesions – thereby retaining the high sensitivity of ultrasound, while at the same time increasing the specificity.

Benign tissue generally shows homogenous optoacoustic signal associated with a homogenous breast tissue chromophore composition, particularly of hemoglobin, fat and water. On the contrary, cancerous tissue has distinct high-intensity patterns representing changes in breast tissue composition.

Malignant breast lesion visualizing tissue chromophores (green: melanin; purple: fat; yellow: blood)
Malignant breast lesion visualizing blood contrast from tumor-feeding vessel on ultrasound background image

Besides changes in tissue composition, vascular patterns are often very indicative of malignant vs. benign lesions. Tumors tend to grow a vascular network that looks distinctly different from that in benign lesions. A frequent expression of this is the presence of large tumor-feeding vessels.

While initial results of investigator-initiated trials by MSOT users suggest that MSOT can help in improving the sensitivity / specificity of breast cancer imaging, further trials are needed to confirm this initial hypothesis. iThera Medical welcomes the opportunity to work with clinical users towards this end.


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