專題討論6:乳癌治療之新進展

S6-1
Update of Breast Imaging – Multimodality Approach
許居誠
三軍總醫院放射診斷部婦女保健中心

  Through randomized, controlled trials and population-based service screening, a 22% to 63% reduction in mortality was observed in women aged 40 to 69 years who received regular mammography screening. Mammography has become the standard of care, but it has never been proved as a diagnostic tool. Even in a symptomatic woman the role of mammography is still to screen the other areas of the same breast, and even the contralateral breast, to rule out occult cancer.

  However, one of the most influential factors that might lower the sensitivity of mammography is dense breast parenchyma. Ultrasound screening in women with dense mammograms shows that an additional 3/1000 cancer could be found with a sacrifice of a lower PPV. In addition, other issues to be overcome with ultrasound screening include operator and patient dependence; the difficulty of detecting microcalcifications and masses when they are small in number or size. With the advance of technology and clinical applications, breast MRI has been proven as an effective diagnostic tool, especially in women with silicone implants, finding occult primary lesions, cancer staging or responses to chemotherapy and any equivocal findings with mammography and ultrasound examinations. Since 2007, ACS has announced a yearly MRI adjunct to mammography as a new guideline for screening high risk women. This article explores the status of the clinical application of these imaging tools in the screening and diagnostic era in Taiwan.