Value-based radiology in breast imaging

Abstract

In this chapter, five common case presentations of everyday situations in the field of Breast Imaging are discussed. We reinforce the importance of following best practice diagnostic guidelines in common issues, such as breast implant complications, assessment of nipple discharge, and the evaluation of the male symptomatic breast. Indeed, these guidelines are not always followed consistently in clinical practice which, in turn, has a direct negative effect on medical resource allocation decisions, contributing to expensive and ineffective procedures, with no additional benefit on healthcare outcomes. We also highlight the role of MRI in the diagnosis and management of breast cancer. This technique combines excellent soft tissue contrast and detailed tumor angiogenesis information which contributes to its success in early cancer detection and in the assessment of treatment response after chemotherapy. Recently, it has also become clear that MRI is superior to mammography on ductal carcinoma in situ diagnosis (discussed in the last case scenario). Finally, we hope that this overview is a useful tool not only for radiologists, including those not familiar with breast imaging, but also for the other members of the multidisciplinary teams composing breast units as well as general practitioners and other physicians that commonly refer symptomatic patients and seek a specialist opinion.