Madrid, 5 November 2024. - The breast radiologist is an indispensable figure in the prevention, detection and monitoring of breast cancer, a pathology that saw 36,395 new diagnoses in Spain in 20241. To coincide with the celebration of International Radiology Day on the 8 November, Dr. Silvia Pérez Rodrigo, Head of the Breast Radiology Department at MD Anderson Cancer Center Madrid – Hospiten, has reiterated the crucial role of these specialists at every stage of the oncology process, directly impacting on the success of treatment and quality of life for patients.
The specialist presents us with the nine essential pillars that describe the work of the radiologist today:
- Screening and early detection: Early detection is vital to improve cure rates and reduce mortality. The breast radiologist interprets mammograms as part of population screening programs, “using advanced technologies, such as digital mammography and tomosynthesis, we can detect millimeter lesions that would be undetectable to the touch,” says the doctor.
- Imaging: Once a suspicious lesion has been identified, the next step is to properly characterize it. The radiologist will determine what additional tests are necessary, combining techniques such as 3D mammography, mammography with intravenous contrast (IVC), breast ultrasound and 3D ultrasound, breast magnetic resonance imaging (breast MRI), where abbreviated protocols of a few minutes in duration have also been incorporated. Finally, we use Artificial Intelligence software that assists us in the diagnostic process, saving us time and helping us in decision-making. “These methods make it possible to evaluate key characteristics of the tumor and plan its treatment”, she adds.
- Deciding and Performing Biopsies: These professionals are responsible for deciding when and how to perform biopsies, which is crucial for an accurate diagnosis. She also points out that: “In many cases, it is important to understand that biopsies are not always performed because we think the lesion is actually malignant, but we do it to confirm that the lesion is benign and thus be able to label it with “name and surname”.
- Tumor characterization: After receiving the results from the pathologist, the radiologist assesses whether they are consistent with the images obtained, which may lead to either additional tests or the initiation of treatment.
- Presentation before the multidisciplinary committee: Each case requiring treatment is discussed in a meeting with other specialists. The radiologist presents the characteristics of the lesions, such as the size and results from the pathologist, which will then determine the treatment plan.
- Pre-surgical marking: At this point, radiologists are “the surgeon's eyes”. We mark the treatment areas with precision, using harpoons or seeds in the precise zones to be treated, facilitating the removal of the tumor and minimizing damage to healthy tissue, which ultimately improves aesthetic and clinical results. “Again, we are the guarantors that both the tumor and the margins have been removed correctly,” she adds.
- Minimally invasive treatments: In some cases, it is possible to treat lesions without surgery and with minimally invasive treatments. “These techniques include systems that freeze the tumor (cryoablation), burn it (radiofrequency, microwave) or remove it through a vacuum biopsy without having to go through the operating room. Imagine leaving the hospital without visible scars and knowing that your tumor is under control, “says Dr. Pérez Rodrigo.
- Evaluation of Response to Treatment: For patients receiving neoadjuvant chemotherapy (chemotherapy before surgery), the radiologist will evaluate the response of the tumor using imaging tests, which are essential to determine the effectiveness of the treatment and thus enable a more conservative intervention.
- Postoperative follow-up: After treatment, we perform continuous monitoring using imaging tests to detect signs of recurrence, adapting the follow-up procedures to the needs of each patient. Techniques such as MRI or intravenous contrast mammography are especially useful for detecting early recurrences.
In short, the work of the breast radiologist encompasses much more than just image interpretation. “We are an integral part of every step of the journey, from screening through to follow-up, and our decisions directly impact the success of treatment and the long-term well-being of patients,” concludes the doctor. The combination of advanced technologies and our expertise enables greater accuracy in diagnoses, treatments that are more personalized and ultimately a better quality of life for patients.
*Attached infographic “The 10 milestones of Radiology in breast cancer”
References:
- Cancer figures in Spain 2023. SEOM