[New trends and novel possibilities in the diagnostic imaging of breast cancer].

Complex tumor therapy development and new opportunities in surgery, which take into account both oncological principles as well as esthetic aspects, have set the requirements far higher for diagnostic imaging of the breast and for radiologists. Despite these new opportunities, X-ray mammography remains the basic examination. However, part of the cancers is hidden on the mammogram, which is partly a consequence of the dense glandular tissue and may also be influenced by the histological type of cancer. Besides reducing radiation dose, digital X-ray mammography improves the examination sensitivity of the dense breast. State of the art digital examination methods, such as tomosynthesis and contrast-enhanced mammography, increase the accuracy of examination. Ultrasound mammography is the most important supplementary method of X-ray mammography. Among the new applications of ultrasound mammography, US elastography, which is based on different tissue elasticity, as well as automatic 3D ultrasound, can be highlighted. Furthermore, among imaging methods that provide functional or metabolic data, MR mammography is the most appropriate non-invasive, non-ionising method for the detection of malignancy and for structure examination. MR mammography is the most sensitive method for the detection of breast cancer and in 20-30% of cases, results in changes of the therapy, and it is also effective in the examination of the dense breast. High level of evidence proves that MR mammography is very useful in the screening of women at risk of breast cancer. Promising results prove that MR mammography will play more considerable role in the evaluation of the effectiveness of the therapy. Diffusion-weighted MR imaging is based on the different diffusion of tissue water, qualitative analysis and quantitative evaluation can be performed. DCE-MR examines that contrast enhancement over time, which can mainly be useful for the qualitative and quantitative evaluation of perfusion changes which may indicate the biological response to tumor therapy. The MR spectroscopic (MRSI) biochemical analysis increases the characterization of the lesions. Multimodal imaging techniques provide more accurate analysis, which is confirmed by more and more evidence, but none of the imaging methods are sufficiently specific to provide histological diagnosis. However, imaging-guided biopsies enable precise histological or cytological confirmation. Technical development, new imaging methods, experienced radiologists and multi-disciplinary cooperation increase the accuracy of the diagnosis and the effectiveness of personalized therapy.