The purpose of this editorial is to provide guidance for the application of (developing) imaging techniques in (1) the non-invasive work-up of breast lesions and (2) staging and characterization of advanced breast cancer. However, the role of several potential imaging investigations has not yet been fully established and existing international guidelines are lagging behind these developments. Non-invasive modalities are increasingly implemented in standard care to support breast cancer diagnosis, staging and evaluation. In the case of proven breast cancer, imaging modalities can have an added value not only to determine the extent of the disease but also to characterize the primary and metastatic breast lesions. The diagnostic work-up of a BI-RADS 3 lesion (chance of malignancy 5 cm), clinical symptoms or laboratory values suggesting the presence of metastases. The work-up for BI-RADS 4 and 5 requires an invasive procedure (biopsy). The guideline for non-invasive diagnostic tests for breast abnormalities of the Agency for Healthcare Research and Quality (AHRQ) in the USA states that for BI-RADS 1 and 2 no further work-up is required. Mammography is scored in five categories according to the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS): category 1, negative 2, benign finding 3, probably benign 4, suspicious finding (chance of malignancy 2–95 %) and 5, highly suggestive of malignancy (chance of malignancy >95 %). Therefore, ultrasound is used in addition to mammography to increase diagnostic accuracy. This technique, however, has limitations in terms of sensitivity (39–86 %) and specificity (88–94 %), depending on age and breast density. Mammography is the primary screening imaging modality. This reduction in mortality is largely due to early detection of malignancies in screening and to better and more personalized therapies. ![]() Although the incidence has increased, mortality has decreased during the last two decades. Worldwide breast cancer has the highest incidence of all malignancies in women.
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