Page - 107 - in Cancer Nanotheranostics - What Have We Learnd So Far?

REVIEWARTICLE published:18December2014 doi: 10.3389/fchem.2014.00112 Molecular imagingofbreast cancer:presentand future directions DavidAlcantara*,ManuelPerniaLeal, IreneGarcía-Bocanegra andMariaL.García-Martín LaboratoryofMetabolomicsandMolecular Imaging,BIONAND,CentroAndaluzdeNanomedicinayBiotecnología (JuntadeAndalucía,UniversidaddeMálaga), Malaga,Spain Editedby: JoãoConde,Massachusetts InstituteofTechnology,USA Reviewedby: MarcPoirot, InstitutNational de la Santéetde laRechercheMédicale, France GiuseppeEsposito,Georgetown UniversityHospital,USA *Correspondence: DavidAlcantara, Laboratoryof MetabolomicsandMolecular Imaging,CentroAndaluzde NanomedicinayBiotecnologia (BIONAND),C/ServeroOchoa,35, 29590Campanillas,Malaga,Spain e-mail: dalcantara@bionand.es Medical imaging technologies have undergone explosive growth over the past few decades and now play a central role in clinical oncology. But the truly transformative power of imaging in the clinical management of cancer patients lies ahead. Today, imaging is at acrossroads,withmolecularly targeted imagingagentsexpected tobroadly expand the capabilities of conventional anatomical imagingmethods.Molecular imaging will allow clinicians to not only see where a tumor is located in the body, but also to visualize the expression and activity of specific molecules (e.g., proteases and protein kinases) and biological processes (e.g., apoptosis, angiogenesis, and metastasis) that influence tumor behavior and/or response to therapy. Breast cancer, themost common cancer among women and a research area where our group is actively involved, is a very heterogeneous disease with diverse patterns of development and response to treatment. Hence, molecular imaging is expected to have amajor impact on this type of cancer, leading to important improvements in diagnosis, individualized treatment, and drugdevelopment, aswell asourunderstandingofhowbreast cancerarises. Keywords: breast cancer,molecular imagingof breast, breast cancer diagnosis, contrast agents, breast imaging techniques,breastmagnetic resonance imaging INTRODUCTION Modern clinical cancer treatments require precise positional information. Where is the tumor located? How large is it? Is it confined, or has it spread to the lymph nodes? Does it involve any critical anatomical structures that would alter the treatment strategy? These questions are being answered, at ever-increasing spatial resolution, through the application of traditional anatomical imaging methods such as computed x- ray tomography (CT),magnetic resonance imaging (MRI), and ultrasound (US). Although these methods still represent the mainstay of clinical imaging, it has become clear that the acqui- sition of molecular and physiological information by nuclear magneticresonanceandoptical imagingtechnologiescouldvastly enhanceourability tofightcancer (Weissleder,2006). Emerging genomic and proteomic technologies have the potential to transform the way in which breast cancer is clini- callymanaged.Molecular imaging ispoised toplayacentral role in this transformation, because it will allow the integration of molecular andphysiological information specific to eachpatient with anatomical information obtained by conventional imaging methods. The hope is that clinical molecular imaging will one day be used to achieve the following: (i) the early detection of molecular orphysiological alterations that signal thepresenceof cancerwhen it is still at acurable stage, (ii) theability toevaluate andadjust treatmentprotocols inreal time,and(iii) theability to streamline thecancerdrugdevelopmentprocess. Thedevelopment of newbreast cancer therapeutics is expen- sive, time-consuming, and often requires vast numbers of patients.Molecular imagingiscurrentlyoneofthemostpowerful non-invasive techniquesused in clinical diagnosis that exhibits a highpotential to improve the efficiency andcost-effectiveness of drug development programs. In this article we present a short review on the main techniques and the perspectives of future BreastCancer Imaging. IMAGINGTECHNIQUESFORBREASTCANCER Mammography and ultrasound are themost commonmethods used for diagnosis and guided intervention in breast disease. The relevanceof breastMRIhasbeenalso increased, fulfiling an importantroleinoperatedbreastsandsuspiciouslesions.Multiple diagnostic techniques, including tomosynthesis,mammography and ultrasound contrast elastography, 3D ultrasound, diffusion andperfusionandbreast spectroscopy,havealsobeendeveloped. Moreover, the use of theAmericanCollege of Radiology (ARC) BIRADS scale (Breast Imaging Reporting andData System) has been implemented in diagnostic centers during the last decade (American College of Radiology, 2003). BIRADS classification started in the late 1980s to address a lack of standardization anduniformity inmammographypractice reporting (McLelland et al., 1991). The BIRADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. Many well-respected groups participated in this developmentinitiativetoestablishabroadbaseofsupport(D’orsi andKopans, 1997; Burnside et al., 2009;Mercado, 2014). TheBIRADS scale is a classification of breast disease accord- ingtoradiologicalfindingsthat includessixgradesofmalignancy and indicates the actions that must be followed for each grade (Figure1). The implementation of BIRADS has allowed us to www.frontiersin.org December2014 |Volume2 |Article112 |107