Molecular imaging to guide breast cancer surgery

Purpose This mini-review aims to provide an overview of the current role of molecular imaging to guide surgery in patients with breast cancer, in non-palpable primary tumours as well as in the management of the axilla in early-stage cancers and when patients receive neoadjuvant systemic therapy. Methods Literature research in the PubMed/MEDLINE database was carried out to identify relevant studies evaluating molecular imaging to guide surgery in breast cancers including molecular breast imaging; breast-specific PET systems; radioguided occult lesion localisation; sentinel node and occult lesion localisation; radioactive seed localisation; sentinel lymph node biopsy and marking axillary lymph nodes with radioactive iodine seeds procedure. Results We summarised the most relevant results on molecular imaging to guide surgery in breast cancers focusing on indications, technical aspects, accuracy and future perspectives. Conclusions Several interventional nuclear medicine techniques are currently available for the management of patients affected by breast cancer in different clinical settings. They provide diagnostic advantages in sub-centimetric lesions or low-grade tumours and help to guide biopsy, also identifying the area with the highest degree of perfusion or metabolism. Nevertheless, some of them are too expensive and not widely spread in hospitals or clinicians still lack confidence in their usage. Further studies are needed to optimise their role in everyday clinical practice.