Imaging in metastatic breast cancer, CT, PET/CT, MRI, WB-DWI, CCA: review and new perspectives

Abstract

Background Breast cancer is the most frequent cancer in women and remains the second leading cause of death in Western countries. It represents a heterogeneous group of diseases with diverse tumoral behaviour, treatment responsiveness and prognosis. While major progress in diagnosis and treatment has resulted in a decline in breast cancer-related mortality, some patients will relapse and prognosis in this cohort of patients remains poor. Treatment is determined according to tumor subtype; primarily hormone receptor status and HER2 expression. Menopausal status and site of disease relapse are also important considerations in treatment protocols. Main body Staging and repeated evaluation of patients with metastatic breast cancer are central to the accurate assessment of disease extent at diagnosis and during treatment; guiding ongoing clinical management. Advances have been made in the diagnostic and therapeutic fields, particularly with new targeted therapies. In parallel, oncological imaging has evolved exponentially with the development of functional and anatomical imaging techniques. Consistent, reproducible and validated methods of assessing response to therapy is critical in effectively managing patients with metastatic breast cancer. Conclusion Major progress has been made in oncological imaging over the last few decades. Accurate disease assessment at diagnosis and during treatment is important in the management of metastatic breast cancer. CT (and BS if appropriate) is generally widely available, relatively cheap and sufficient in many cases. However, several additional imaging modalities are emerging and can be used as adjuncts, particularly in pregnancy or other diagnostically challenging cases. Nevertheless, no single imaging technique is without limitation. The authors have evaluated the vast array of imaging techniques – individual, combined parametric and multimodal - that are available or that are emerging in the management of metastatic breast cancer. This includes WB DW-MRI, CCA, novel PET breast cancer-epitope specific radiotracers and radiogenomics.

The circulating immune cell landscape stratifies metastatic burden in breast cancer patients

“…In addition to circulating tumour DNA (ctDNA), PBMCs offer unique advantages in accessibility, sensitivity and real-time assessment of tumour dynamics. Unlike imaging techniques that may have limitations in detecting microscopic lesions [69] [70] [71], systemic PBMC composition and marker genes can offer a minimally invasive approach to capture comprehensive molecular information about tumours. While ctDNA analyses provide a snapshot of the mutational landscape of tumour cells, PBMC profiling allows for an indirect evaluation of the local immune system at both primary and metastatic sites.…”

The emerging roles of long non-coding RNA (lncRNA) H19 in gynecologic cancers

“…The current landscape of GC diagnosis and treatment embraces a multidisciplinary strategy that integrates diverse methodologies and technological advancements [ 10 ]. To evaluate the size and metastasis of GCs, imaging modalities such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans are routinely employed [ 11 ]. Also, various biopsy techniques, including colposcopy [ 12 ], endometrial biopsy [ 13 ], hysteroscopy [ 14 ], and laparoscopy [ 15 ], are utilized to procure tissue samples from suspected tumors or abnormal regions for further analysis and confirmation.…”

Bone Scans in Preoperative Investigations of Breast Cancer Cases

“…Due to the high cost of BS and the common occurrence of early-stage breast cancers, substantial healthcare savings could be attained by minimizing or excluding BS for asymptomatic individuals [ 10 ].…”