Unnecessary biopsies are associated with potential harms, including increased anxiety, complications from the procedure, and medical costs. Despite advances in breast imaging, breast biopsy remains the only definitive way to determine whether a suspicious lump is cancerous.My work as an engineer focuses on improving imaging technology to detect and diagnose cancer. Breast cancer grows when the tumor forms new blood vessels and consumes more oxygen. This makes examining blood vessels and oxygen levels potential biomarkers that could improve breast cancer diagnosis.Diffuse optical tomography, or DOT, is an imaging technique that uses near-infrared light to measure total blood hemoglobin concentration and oxygen levels – key indicators of tumor activity – in a breast lump. Patients do not require injections of contrast dyes to make the image clearer.My team and I found that combining ultrasound with DOT can improve the accuracy of breast cancer diagnosis and reduce unnecessary breast biopsies. Ultrasound provides information about the structure of a breast lump, while DOT provides information about its function, and together these data can improve the diagnosis of breast cancer.Improving breast ultrasound with DOT —————————————————– In our study, we imaged 226 patients recommended for routine breast biopsy using our new hand-held imaging technique, which combines ultrasound with diffuse optical tomography. These patients had either breast cancer or a benign lump, and their final diagnosis was confirmed by biopsy.Radiologists initially evaluated each patient using standard imaging methods such as ultrasound and mammography. They then reviewed additional information from the DOT images. Importantly, the radiologist and engineer were unaware of the biopsy results when determining the diagnosis.We observed significant biological differences between cancerous and benign tumors. Cancerous lesions had significantly higher hemoglobin levels and significantly lower oxygen levels compared to non-cancerous tissues. More aggressive cancers showed higher hemoglobin concentrations and lower oxygen levels than less aggressive tumors.When radiologists were able to review DOT measurements, biopsies of benign tumors decreased by approximately 25%. The false-negative rate was 1.8%, which is in line with medical guidelines that recommend monitoring rather than immediate biopsy.The future of breast cancer screening and diagnosis —————————————————— Breast cancer is the most common cancer in women worldwide. Nearly 2.3 million new cases and 670,000 deaths were recorded in 2022. If these rates continue, researchers estimate there will be approximately 1.1 million breast cancer-related deaths in 2050.More accurate, non-invasive diagnostic tools could not only reduce unnecessary biopsies but also lead to more accurate and efficient diagnoses. In addition to ultrasound, researchers have also explored combining other imaging techniques with DOT, including X-ray mammography, 3D mammography, and MRI.However, DOT systems combined with mammography and MRI are more difficult for routine use in the clinic than ultrasound. My team is working to further refine our technology, including incorporating AI tools to help process the imaging data.Reducing avoidable procedures can help maintain a patient’s quality of life and reduce health care costs. I believe that these reforms can collectively have a meaningful and far-reaching impact on patient care and the broader health care system.