Technology for Early Detection and Screening
Conventional two-dimensional (2D) mammography machines use a low-dose X-ray system to create a single, flattened image of the breast from two standard angles. These machines are engineered to detect subtle architectural distortions, small masses, and clusters of microcalcifications, which can sometimes indicate the presence of cancer. The limitation of 2D mammography is that overlapping normal breast tissue can sometimes obscure a tumor or create the appearance of an abnormality that is not truly present.
The current standard of care increasingly involves three-dimensional (3D) mammography, known as Digital Breast Tomosynthesis (DBT). A DBT machine captures a series of low-dose X-ray projections as the X-ray tube moves in an arc over the compressed breast. A powerful computer algorithm then reconstructs these projection images into thin, cross-sectional slices, typically one millimeter thick.
This slice-by-slice viewing capability allows a radiologist to effectively look past overlapping breast structures, which is particularly beneficial for individuals with dense breast tissue. The improved clarity of DBT helps distinguish between actual lesions and superimposed tissue, leading to an increased cancer detection rate and a reduction in unnecessary follow-up imaging. Both 2D and 3D mammography require the breast to be firmly compressed between two plates to spread the tissue evenly, which minimizes the required radiation dose and achieves a clear image.
Advanced Imaging Used for Diagnosis
Once an abnormality is identified during screening, Breast Ultrasound systems utilize high-frequency sound waves, rather than X-rays, to produce real-time images of breast tissue. The ultrasound transducer, a handheld device, transmits sound waves into the breast and records the returning echoes, which are then translated into an image.
Ultrasound is particularly useful as a follow-up tool to determine if a suspicious mass seen on a mammogram is a solid tumor or a fluid-filled cyst. It is often used as a supplementary screening tool for individuals with dense breasts, where mammography can be less sensitive. These systems are also routinely employed to guide a needle precisely during tissue sampling procedures.
Magnetic Resonance Imaging (MRI) machines offer the highest sensitivity for detecting breast cancer and are primarily reserved for diagnostic workups and high-risk screening. The MRI uses powerful magnets and radio waves to align the protons in the body’s water molecules, measuring the signals emitted as they return to their normal state. The process requires the injection of a gadolinium-based contrast agent, which is taken up rapidly by tumors, making them appear brightly on the resulting detailed images. This high-resolution imaging is used to accurately determine the extent of the disease, assess the presence of multiple tumors, and evaluate the response to pre-operative chemotherapy.
Specialized Devices for Tissue Biopsy
Diagnosis requires the extraction of tissue samples, performed using specialized core biopsy devices guided by imaging machinery. For non-palpable lesions, particularly microcalcifications only visible on a mammogram, a stereotactic biopsy system is used. This system uses two X-ray images taken from slightly different angles to allow a computer to triangulate the exact three-dimensional coordinates of the target lesion.
Tissue removal is performed with a core needle biopsy (CNB) or, more commonly, a vacuum-assisted biopsy (VAB) device. Standard CNB devices use a hollow, wide-gauge needle to capture a core of tissue. VAB systems, such as the Mammotome, employ a single-insertion needle with a side aperture.
A vacuum pump connected to the needle applies suction, drawing the target tissue into the aperture. A motorized, rotating cutter then severs the tissue, which is transported into a collection chamber through the hollow needle. This process allows for the collection of multiple, larger tissue samples—sometimes five to twenty cores—without having to repeatedly reinsert the needle, which significantly improves diagnostic accuracy.
Machinery for Targeted Treatment Delivery
For external beam radiation therapy, the primary machine is the Linear Accelerator, or LINAC. The LINAC is a large device that accelerates electrons to high energies, which are then directed to a target to produce high-energy X-rays or electron beams designed to precisely destroy cancerous cells while minimizing damage to surrounding healthy tissue.
These high-energy beams are shaped and aimed using sophisticated computer-controlled multi-leaf collimators that conform the radiation field to the tumor’s exact size and shape. Modern LINACs are integrated with advanced imaging systems, allowing technicians to verify the tumor’s position immediately before and during treatment, a technique called Image-Guided Radiation Therapy (IGRT). This precision allows for the delivery of higher radiation doses directly to the tumor while safely sparing nearby organs, such as the heart and lungs, which is important in treating left-sided breast cancer.
Beyond radiation, specialized surgical and ablative devices offer minimally invasive treatment options. Robotic surgical systems, such as the da Vinci platform, allow surgeons to perform complex procedures like nipple-sparing mastectomies through small incisions. The system translates the surgeon’s hand movements into precise, magnified movements of miniature instruments, enhancing visualization and dexterity within the surgical field.
For localized destruction of small tumors, thermal ablation techniques employ specialized probes guided by ultrasound. Devices for cryoablation insert a thin probe into the tumor and circulate a super-cooled gas like argon, forming an ice ball that freezes and destroys the cancerous tissue. Other thermal devices, such as those used for laser or radiofrequency ablation, use heat to achieve the same result, offering a minimally invasive alternative to traditional surgery for select early-stage cancers.