Breast MRI: Diagnosis and Intervention + 1040 Illustrations / edited by Elizabeth Morris, Laura Liberman.
The book you are about to read is certainly important in itself, as it is an authoritative, practical, and scholarly guide to one of the most rapidly changing and increasingly valuable areas in breast medicine. But its true significance is best appreciated from the long-term historical perspective.
The advances in diagnostics and therapeutics that have transformed our modern world are the results of a revolution in biomedical philosophy that, while starting in the first centuries of the Common Era, is still in progress. This slow but inexorable ascendancy of the organ-based medical tradition of the Arabian-Persian-Hebrew schools and consequent decline of the ancient Greek reliance on manipulation of humors (“feed a cold; starve a fever”) has brought functional anatomy into the very center of our thinking.
Yet what began with vague concepts of gross organs and organ systems has now progressed into highly sophisticated cell biology, biochemistry, and genetics, even while structure-function linkage has been preserved as the rational core. We have learned to describe phenomena in increasing levels of detail, from the whole tissue down to the level of the single molecule. The process has spun off dramatic improvements in detection, prognostication. and intervention, and promises much, much more.
Seen in this context, the rise of magnetic resonance imaging of the breast is a vital contemporary example of an enduring historical development.The twentieth century saw both the emergence of breast surgery as the first treatment capable of curing some cases of breast cancer and its enhancement by radiation therapy and systemic drug administration.
Breast imaging coevolved both to guide the therapeutic hand and to improve the diagnostic hand, thereby vastly augmenting the value of all three treatment modalities. But what we read in these pages is not just a chronicle of advances in the art of visualizing a mass. We arc thrust into the middle of a sea change in our ability to assess—simultaneously and non-invasivcly or minimally invasively—the structure and function of the cells from which cancers arise and are sustained.
Hence, contemporary technology is beginning to provide what twenty centuries of medical progress has sought, a melding of anatomy, physiology, and therapeutics in real time and to strikingly beneficial effect. Fundamental concepts of the normal and cancerous breast arc being challenged. Venerable terms like preneoplastic stroma, preinvasive carcinoma, multifo-cality, and margin assessment are being redefined.
Our access to the earliest events in breast disease, the molecular events, is opened wider. Where all of this will lead is, of course, unknowable, but the direction is clear: clearer and deeper and more integrated understanding, all in the service of better management. That is the big picture, and that is what these pages really signify.
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