The role of positron emission mammography in breast cancer imaging and management

April 2008 Breast cancer is one of the most frequently diagnosed cancers in women, touching the lives of roughly 213,000 women in 2006. In addition to invasive breast cancer, approximately 62,000 cases of in situ breast cancer were projected to occur in 2006, with 85% of these being ductal carcinoma in situ. Even with these increased numbers, mortality is decreasing. Screening mammography has been the gold standard for breast cancer surveillance for 3 decades and is credited with decreasing mortality by 33%. Because mammography has resulted in earlier detection of breast cancer, more patients today are candidates for, and choose, breast-conserving surgery instead of mastectomy. However, mammography is frequently inadequate as a planning tool for lumpectomy. In addition, it has very limited value in women with dense breasts. This may explain the finding that residual cancer can be found in as many as 30% to 60% of patients after lumpectomy, resulting in a second trip to the operating room. One goal of molecular imaging is to preoperatively identify which patients are best served by lumpectomy and define the margins for surgery by identifying metabolic abnormalities in tissue, potentially decreasing the number of second surgeries needed for resection of residual disease. Any technology that could more precisely map the extent of both invasive and noninvasive disease would lead to more precise surgery. This article will review the history of molecular imaging in breast cancer with a special emphasis on the use of the new technology positron emission mamography (PEM), in preand postoperative breast cancer management.