Breast imaging in the new era

In the last decade, there have been huge advances in the field of breast imaging. Full field digital mammography systems optimise lesion to background contrast with resultant improvement in the sensitivity of the technique for cancer detection, facilitated by computer-aided detection. Though mammography remains the only established modality for population-based screening, preliminary results from several large studies indicate that magnetic resonance imaging (MRI) has a role in high-risk patients. On the other hand, advances in ultrasound, MRI and nuclear medicine have the potential to greatly improve the specificity of breast imaging with regard to cancer detection and lesion characterisation. A number of new and experimental techniques are being developed which may have great impact in this area and these will be discussed. Though MRI now has an established place in the diagnosis of breast cancer, it is becoming clear that it can directly affect surgical and medical management by enabling assessment of response to chemotherapy and endocrine therapy, and facilitating choice of the most appropriate surgery. Just as the role of MRI has evolved, so too the place of nuclear medicine, particularly positron emission tomography and radio-immunoscintigraphy should become clearer in the next few years.