Table 2.

Technological advances in the local evaluation and treatment of breast cancer

Technique	Past	Present	Future
Definition of ductal anatomy	Contrast radiography	Direct endoscopic visualization	Intraductal excision of lesions
Breast cancer screening	Film mammography	Digital mammography	Possibly digital tomosynthesis
Preoperative evaluation of the extent of disease	Film mammography, ultrasonography	Digital mammography with computer-assisted detection, ultrasonography, MRI in selected circumstances	Possibly digital, tomosynthesis, ultrasonography, MRI
Breast-conserving surgery	Palpation	Wire localization	Molecular probes
Surgical specimen evaluation	Gross and microscopic evaluation	Orientation of specimen, inking of margins, specimen radiograph, directed sectioning	3-D specimen imaging and imaging–pathology correlation
Axillary staging	Axillary node dissection	Sentinel lymph node biopsy	Preoperative imaging of axillary nodes +/− biopsy, sentinel lymph node biopsy
Tumour classification	Histologic type, size	Grade, lymphovascular invasion, ER, PR, Her2-neu oncogene expression	Genotyping
Gene expression	ER, PR	ER, PR, Her2-neu expression, Mammaprint,* Oncotype DX*	Gene array–based individualized treatment
Radiotherapy	Whole-breast radiation	Conformal whole-breast radiation	Partial-breast radiation

3-D = 3-dimensional; ER = estrogen receptor; PR = progesterone receptor; MRI = magnetic resonance imaging.

^*Clinical trial.