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Spie Press Book

Diagnostic and Therapeutic Applications of Breast Imaging
Editor(s): Jasjit S. Suri; S. Vinitha Sree; Kwan-Hoong Ng; Rangaraj M. Rangayyan
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Book Description

This book presents the established and currently researched diagnostic and therapeutic imaging techniques used for breast cancer. Section I is a review of the principles, applications, and recent advances of breast imaging modalities. Section II focuses on breast pathologies and presents the use of breast cancer subgross morphology parameters. Section III covers mammography. Section IV focuses on CAD techniques used in breast cancer detection. Section V is dedicated to breast ultrasound, and Section VI discusses the role of magnetic resonance imaging in breast imaging. Thermal imaging in breast cancer is the theme of Section VII, and Section VIII concludes with chapters on breast cancer treatment.

Book Details

Date Published: 22 February 2012
Pages: 542
ISBN: 9780819487896
Volume: PM211

Table of Contents
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List of Contributors
Acronyms and Abbreviations
I Physics of Breast Imaging
1 Breast Imaging Modalities: Principles, Applications, and Recent Advances
S. Vinitha Sree, E. Y. K. Ng, U. Rajendra Acharya, and Jasjit S. Suri
1.1 Introduction
1.2 Mammography
      1.2.1 Principle
      1.2.2 Advances and applications
1.3 Ultrasound
      1.3.1 Principle
      1.3.2 Advances and applications
1.4 Magnetic Resonance Imaging
      1.4.1 Principle
      1.4.2 Advances and applications
1.5 Computed Tomography
      1.5.1 Principle
      1.5.2 Advances and applications
1.6 Positron Emission Tomography
      1.6.1 Principle
      1.6.2 Advances and applications
1.7 Scintimammography
      1.7.1 Principle
      1.7.2 Advances and applications
1.8 Optical Imaging
      1.8.1 Principle
      1.8.2 Advances and applications
1.9 Electrical-Impedance-Based Imaging
      1.9.1 Principle
      1.9.2 Advances and applications
1.10 Thermography
      1.10.1 Principle
      1.10.2 Advances and applications
1.11 Molecular Imaging
1.12 Conclusion
II Breast Pathology
2 Subgross Morphology Parameters in Breast Cancer and Their Prognostic and Predictive Power
Tibor Tot and Dragana Bogdanovic-Stojanovic
2.1 Introduction
2.2 Normal Breast Tissue: Aberrations and Variations through Benign Lesions–a Continuum
2.3 The Sick Lobe
2.4 Malignant Transformation within the Sick Lobe
      2.4.1 Peripheral pattern
      2.4.2 Segmental and lobar patterns
2.5 Subgross Morphological Parameters in Invasive Breast Carcinomas
      2.5.1 Tumor shape
      2.5.2 Tumor size: early and advanced breast carcinoma
      2.5.3 Tumor multifocality
      2.5.4 Diffuse invasive growth
      2.5.5 Intratumoral and intertumoral heterogeneity
      2.5.6 Extent of the disease
2.6 Conclusions
III Mammography
3 Diagnostic Mammography in Breast Imaging
Malai Muttarak, Chintana Paramagul, and Kwan-Hoong Ng
3.1 Introduction
3.2 Common Supplemental Mammographic Views
      3.2.1 Lateral view
      3.2.2 Spot compression view
      3.2.3 Magnification view
      3.2.4 Exaggerated craniocaudal view
      3.2.5 Cleavage view
      3.2.6 Tangential view
      3.2.7 Rolled or change-of-angle view
      3.2.8 Implant displacement view
3.3 Diagnostic Mammography in Various Symptomatic Patients
      3.3.1 Evaluation of a palpable breast mass in women older than 30 years
      3.3.2 Evaluation of patients presenting with nipple discharge
      3.3.3 Evaluation of patients presenting with skin or nipple changes
      3.3.4 Evaluation of patients presenting with axillary masses
      3.3.5 Evaluation of a palpable mass in men
3.4 Conclusion

4 Role of Mammography in Screening for Breast Cancer: Is It Still the Gold Standard?
Selin Carkaci and Lumarie Santiago
4.1 Introduction
4.2 Common Supplemental Mammographic Views
4.3 Breast Cancer Screening Programs
4.4 Disadvantages of Screening Mammography
      4.4.1 Screening recall rates
      4.4.2 Radiation exposure
      4.4.3 Anxiety
      4.4.4 Mammography and false-positive results
4.5 Disadvantages of Screening Mammography
      4.5.1 Diagnosis of ductal carcinoma in situ
      4.5.2 Age to begin screening
      4.5.3 Breast density affectations in mammographic sensitivity
      4.5.4 Cost effectiveness
4.6 Advantages of Digital Mammography in Screening for Breast Cancer
4.7 Supplemental Screening with Magnetic Resonance Imaging and Ultrasound
      4.7.1 Breast ultrasound
      4.7.2 Magnetic resonance imaging
4.8 Conclusions

5 Lossless Compression of Digital Mammographic Images
Ravikumar Mulemajalu and Shivaprakash Koliwad
5.1 Introduction
5.2 Introduction to Digital Mammography
5.3 Storage and Related Constraints
5.4 Data Compression
      5.4.1 Encoding and decoding
5.5 Digital Images
      5.5.1 Storage of digital images
      5.5.2 Image compression
      5.5.3 Compression measures
5.6 Information Theory Fundamentals
      5.6.1 Entropy
      5.6.2 Redundancy
5.7 Spatial Prediction
      5.7.1 Context modeling
      5.7.2 Lossless JPEG
      5.7.3 JPEG-LS
5.8 Transform-Based Techniques
      5.8.1 JPEG 2000
5.9 Functionality Comparison
5.10 Lossless Compression of Mammographic Images
5.11 Image Databases for Mammographic Research
      5.11.1 Mammographic Image Analysis Society (MIAS) database
      5.11.2 Digital Database for Screening Mammography (DDSM)
5.12 Compression Performance Comparison
5.13 Summary

IV Computer-Aided Diagnosis Techniques

6 Image Processing and Pattern Classification Techniques for the Detection of Architectural Distortion in Prior Mammograms of Interval-Cancer Cases
Shantanu Banik, Rangaraj M. Rangayyan, and J. E. Leo Desaults
6.1 Introduction
6.2 Detection of Architectural Distortion
      6.2.1 Architectural distortion
      6.2.2 Detection of architectural distortion by CAD systems
      6.2.3 Analysis of prior mammograms
6.3 Methods
      6.3.1 Experimental setup and database
      6.3.2 Detection of potential sites of architectural distortion
      6.3.3 Feature extraction
      6.3.4 Feature analysis, selection, and classification methods
6.4 Results
      6.4.1 Interval-cancer cases only
      6.4.2 Interval-cancer cases and normal control cases
6.5 Discussion and Conclusion

7 Evaluating the Performance of Digital Mammography Systems: Physical and Psychophysical Characterization
Nico Lanconelli and Stefano Rivetti
7.1 Introduction
7.2 Detector Technology
      7.2.1 Introduction
      7.2.2 Computed radiography
      7.2.3 Flat-panel detectors
      7.2.4 Slot-scan technology
7.3 Physical Characterization
      7.3.1 Modulation transfer function
      7.3.2 Noise analysis
      7.3.3 Noise-equivalent quanta and detective quantum efficiency
      7.3.4 Results of commercial systems
7.4 Psychophysical Characterization
      7.4.1 Theoretical models
      7.4.2 Contrast-detail phantoms
      7.4.3 Results of commercial systems
7.5 Quality Assurance Programs
      7.5.1 Protocols
      7.5.2 Phantoms
      7.5.3 Automatic exposure control setup and average glandular dose
      7.5.4 Parameters and limits

8 Evaluation of the Biofield Diagnostic System for Breast Cancer Detection Based on Clinical Trial and Data Mining Techniques
S. Vinitha Sree, E. Y. K. Ng, U. Rajendra Acharya, and Jasjit S. Suri
8.1 Introduction
8.2 The Biofield Diagnostic System (BDS)
      8.2.1 Principle
      8.2.2 Data acquisition
      8.2.3 Past clinical trial results
8.3 Methodology
      8.3.1 Clinical trial methodology
      8.3.2 Data mining methodology
8.4 Results and Discussion
      8.4.1 Clinical trial results
      8.4.2 Data mining results
8.5 Conclusion

V Breast Ultrasound

9 The Role of Ultrasound in the Diagnosis of Breast Disease
Wei Tse Yang
9.1 Introduction
9.2 Breast Imaging Reporting and Data System Ultrasound Nomenclature
9.3 Adjunct Imaging Method to Mammography and Clinical Breast       Examination
9.4 Primary Imaging Modality for Symptomatic Young and Pregnant Patients
9.5 The Acute Breast
9.6 Differentiating Between Benign and Malignant Lesions
9.7 Color Doppler and Power Doppler Imaging
9.8 Imaging Guidance for Interventional Procedures
9.9 Breast Cancer Imaging
9.10 Tumor Response
9.11 Second-Look Ultrasound After a Positive Breast Magnetic-Resonance or PET Scan Study
9.12 Limitations
      9.12.1 Operator dependence and reproducibility
9.13 Future Directions
      9.13.1 Elastography in breast imaging
      9.13.2 Breast ablation techniques
      9.13.3 3D sonography

VI Breast Magnetic Resonance Imaging and Computed Tomography

10 The Role of Breast Magnetic Resonance Imaging in the Diagnosis of Breast Disease
Basak E. Dogan
10.1 Introduction
10.2 Breast Magnetic Resonance Imaging
10.3 American College of Radiology BI-RADS® Breast MRI Reporting System
      10.3.1 Focus and foci
      10.3.2 Masses
      10.3.3 Non-mass-like enhancements
10.4 Typical Breast MRI Findings of Common Pathologies
      10.4.1 Malignant breast lesions
      10.4.2 Benign fibrocystic changes
10.5 Clinical Breast MRI Applications
      10.5.1 High-risk breast cancer screening
      10.5.2 Preoperative local staging and surgical planning
      10.5.3 Staging invasive breast cancer
      10.5.4 Determining the extent of ductal carcinoma in situ
      10.5.5 Monitoring patient response to neoadjuvant chemotherapy
      10.5.6 Axillary breast cancer metastasis from an unknown primary
10.6 MRI-Guided Breast Biopsy
10.7 Summary

VII Breast Thermography

11 Color Segmentation and Fractal Analysis of Breast Thermograms
Mahnaz Etehad Tavakol, E. Y. K. Ng, Caro Lucas, and Saeed Sadri
11.1 Introduction
11.2 Pseudocolor Images
11.3 Color Segmentation Algorithms
      11.3.1 k-means clustering
      11.3.2 Mean-shift clustering
      11.3.3 Fuzzy c-means clustering
11.4 Experimental Results for Color Segmentation
11.5 Application of Angiogenesis
11.6 Applications of Fractal Analysis in Biomedical Images
11.7 Fractal Dimension
11.8 Experimental Results for Fractal Analysis
11.9 Conclusion

12 Automatic Identification of Breast Cancer Using Texture Features from Infrared Thermograms
U. Rajendra Acharya, E. Y. K. Ng, S. Vinitha Sree, and Jasjit S. Suri
12.1 Introduction
12.2 Data Acquisition and Preprocessing
12.3 Texture Features
      12.3.1 Gray-level co-occurrence matrix
      12.3.2 Run-length matrix
12.4 Classifiers
      12.4.1 Back-propagation neural network
      12.4.2 Gaussian mixture model
      12.4.3 Support vector machine
      12.4.4 Fuzzy classifier
      12.4.5 Linear discriminant analysis and quadratic discriminant analysis
      12.4.6 Probabilistic neural network
12.5 Results
      12.5.1 Features
      12.5.2 Classification results
      12.5.3 Graphical user interface
12.6 Discussion
12.7 Conclusion

VIII Therapeutic Applications

13 Imaging for Autologous Breast Reconstruction
Matteo Atzeni, Luca Saba, Jasjit S. Suri, Giorgio Mallarini, and Diego Ribuffo
13.1 Introduction
13.2 Pedicled/Free Transverse Rectus Abdominis Myocutaneous Flaps
13.3 Perforator Flaps
      13.3.1 Deep inferior epigastric perforator flap
      13.3.2 Superficial inferior epigastric artery flap
      13.3.3 Superior and inferior gluteal artery perforator flaps

14 Breast Cancer Treatment and Nanomedicine
Swati Gupta and Sachin Yadav
14.1 Breast Cancer
      14.1.1 Signs and symptoms
      14.1.2 Risk factors
      14.1.3 Pathophysiology
14.2 Treatment of Breast Cancer
      14.2.1 Local therapy
      14.2.2 Systemic therapy
14.3 Novel Targets in Breast Cancer Therapy
      14.3.1 Anti-epidermal growth factor receptor
      14.3.2 Farnesyl transferase inhibitors
      14.3.3 Epothilones
      14.3.4 Nab-paclitaxel (nanoparticle albumin-bound paclitaxel): reducing toxicity using albumin-bound particles as the carrier for       paclitaxel
      14.3.5 Antiangiogenic agents in breast cancer
      14.3.6 Epigenetic regulation as a new target for breast cancer therapy
      14.3.7 DNA methylation
      14.3.8 Tumor vaccines for breast cancer
      14.3.9 Antigen-based vaccine
      14.3.10 Cell-based vaccines
14.4 Targeting Approaches
      14.4.1 Passive targeting by nanoparticles
      14.4.2 Active targeting by nanoparticles
14.5 Various Strategies for Targeting Breast Cancer
      14.5.1 Human epidermal growth factor receptor-2
      14.5.2 Estrogen receptor
      14.5.3 Vascular endothelial growth factor
      14.5.4 Insulin-like growth-factor-binding protein-3
      14.5.5 Gene silencing by small interfering RNA
      14.5.6 Aptamer
14.6 Role of Nanocarriers in Breast Cancer
      14.6.1 Nanocarrier drug delivery
      14.6.2 Need of nanocarriers
      14.6.3 Limitations
14.7 Various Nanocarrier Systems
      14.7.1 Liposomes
      14.7.2 Solid lipid nanoparticles
      14.7.3 Lipid emulsions
      14.7.4 Dendrimers
      14.7.5 Micelles
      14.7.6 Carbon nanotubes
      14.7.7 Gold nanoparticles
      14.7.8 Microspheres
      14.7.9 Niosomes
      14.7.10 Quantum dots
      14.7.11 Nanoshells
      14.7.12 Nanobubbles
      14.7.13 Paramagnetic nanoparticles
14.8 Conclusion



Breast cancer is the most frequently occurring malignancy in women and has a high mortality rate. It is important and necessary to find effective treatments and develop better early detection modalities, and therefore, improve the chances of survival and reduce healthcare costs. The chapters in this book present the established and currently researched diagnostic and therapeutic imaging techniques used for breast cancer.

The book is divided into eight sections. Section I is a review of the principles, applications, and recent advances of breast imaging modalities. Section II focuses on breast pathologies and presents the use of breast cancer subgross morphology parameters. Section III deals with mammography. Section IV focuses on computer-aided diagnostic (CAD ) techniques used in breast cancer detection. Section V is dedicated to breast ultrasound, and Section VI discusses on the role of magnetic resonance imaging (MRI) in breast imaging. Thermal imaging in breast cancer is the theme of the chapters in Section VII. Section VIII includes chapters on breast cancer treatment. A brief summary of the chapters is given below.

Chapter 1 summarizes the principle behind several breast cancer imaging modalities, reviews the various advances made in these modalities, and also discusses the utilities of these modalities in the various stages of breast cancer management, namely, during primary screening of cancer, in the diagnosis and characterization of lesions, during staging and restaging, as part of treatment selection and treatment progress monitoring, and in determining the cancer recurrence possibility. Subgross-morphology-based methods represent a level half a way between the low-resolution radiological imaging methods and the high-resolution microscopic analysis. The subgross morphology parameters are diagnostic features in breast carcinoma, some of which are established morphological prognostic parameters.

Chapter 2 reviews the subgross morphology of normal and pathologically altered breast tissue and specifically focuses on the association of subgross morphological details with prognostic and predictive parameters in breast carcinoma. The authors also present the morphological parameters that need to be assessed to adequately characterize breast carcinoma.

Chapter 3 discusses the use of diagnostic mammography. With the widespread implementation of full-field digital mammography, the role of breast imaging in diagnosis and screening is undergoing rapid advances. This chapter highlights the importance of positioning and discusses mammographic views, radiographic techniques, and reporting methods. The chapter also describes the ways to use diagnostic mammography for the evaluation of cases with specific symptoms.

Breast cancer screening can detect the presence of the disease at its earliest stages in asymptomatic women. Studies have indicated that such screening with mammography has resulted in breast cancer mortality reduction by up to 44%. Chapter 4 presents a review of the randomized controlled trials of screening mammography, breast cancer screening programs, advantages, limitations, and controversies associated with screening mammography, and supplemental screening for breast cancer with ultrasound and breast MRI.

Mammographic images have high resolution and therefore require large storage space and huge transmission bandwidth. In Chapter 5, the authors review several lossless compression methods that are currently used to reduce the size of these images for easy storage and transmission. The chapter presents basics of information theory, describes terminologies used in this domain, and tabulates a comparison of the performances of several compression techniques evaluated in the literature.

Architectural distortion, one of the common signs of nonpalpable breast cancer, is also one of the reasons for reduced sensitivity in mammograms. Chapter 6 presents methods for the detection of this abnormality using techniques such as Gabor filters, phase portrait analysis, fractal analysis, and texture analysis. The authors present the results obtained by using these techniques and several classifiers for classifying several normal and abnormal regions of interests extracted from mammograms. The authors demonstrate that their proposed methodology is a good candidate for detecting architectural distortion in prior mammograms of interval-cancer cases.

Chapter 7 illustrates some of the methods used for evaluating the physical and psychophysical performance of digital detectors for imaging in mammography. The chapter also presents a description of the detector technology. The wide scope of quality assurance programs helps guarantee the high level of efficiency of the overall diagnostic procedure; this chapter describes the quality assurance protocols currently in practice.

Many studies have analyzed and found significant differences between the electrical characteristics of benign breast tissue and those of malignant breast tissue. Chapter 8 introduces a relatively new adjunct modality for breast cancer detection called the Biofield Diagnostic System (BDS). The chapter describes in detail the principle and the data acquisition procedure of BDS and presents the clinical trial results obtained by using this modality. The chapter also presents the utility of classifiers in improving the prediction accuracy of BDS.

Chapter 9 summarizes currently accepted indications for the simple, inexpensive, widely available, and effective breast ultrasound technique. It also highlights several potential areas of development and applications, such as elastography, breast ablation techniques, and 3D ultrasound. Breast MRI is a recommended technique for specific applications such as breast cancer screening in a high-risk population, staging of ipsilateral breast cancer, and concurrent screening for contralateral breast cancer in a woman diagnosed with breast cancer. Chapter 10 presents the basic technical requirements for breast MRI, illustrated clinical applications, and MRI-guided intervention techniques. The authors also highlight the controversies surrounding breast MRI and give several suggestions for effectively utilizing this powerful technique.

In spite of the arguable history on the effectiveness of breast thermography, the availability of highly sensitive infrared cameras and the development of advanced imaging processing techniques have created more research interest in the field of breast thermography. In Chapter 11, the authors model and compare the performances of three color segmentation techniques (k-means, mean shift, and fuzzy c-means) for segmentation of infrared breast images. They also evaluate the use of fractal dimension for thermal image analysis.

Chapter 12 presents another CAD tool for thermogram analysis. The authors demonstrate the use of texture features that were extracted from normal and cancerous thermograms in several classifiers in order to develop a classification model for differentiating cancerous and normal breasts. After evaluating several classifiers, the authors found that the support vector machine classifier presented a high accuracy of 88.10% when significant textures features were used to train and test the classifier.

An ideal breast reconstructive technique should be safe, reliable, and reproducible, with limited or no resultant long-term morbidity. In order to accurately harvest the flaps for autologous reconstruction, an accurate preoperative evaluation of the area of harvest of the flap is necessary. In Chapter 13, the authors describe several flaps used in current practice and also discuss the imaging modalities used for preoperative evaluation and planning.

Treating the detected cancer effectively goes a long way in improving the survival rate. Chapter 14 summarizes the types of therapies that are currently in practice. It describes in detail local and systemic therapies and also presents novel targets that are used in therapy. The targeting approaches, with a specific highlight on the nanoparticle targeting methods, are detailed. The chapter concludes by presenting a comprehensive account on the role of nanocarriers in breast cancer.

Jasjit S. Suri
S. Vinitha Sree
Kwan-Hoong Ng
Rangaraj M. Rangayyan
January 2012

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