Research Spotlight - Breast Cancer Awareness Month: Dr. Siew Ching Tiong

For Breast Cancer Awareness Month, Medical Imaging is spotlighting the incredible research happening in the Breast Imaging department, including that of Dr. Siew Ching Tiong, a breast imaging fellow with the Joint Department of Medical Imaging (JDMI).

Originally from Malaysia, Dr. Tiong completed her medical training in Singapore and practiced as a general radiologist but had an interest in working within breast imaging.

“I’ve found breast imaging to be a really interesting field as it combines everything in the practice of medicine, from patient care, problem solving, and procedures to multidisciplinary teamwork, public health, and advocacy,” Dr. Tiong says.

With her keen interest and under the supervision of Dr. Viviane Freitas, JDMI, Dr. Tiong has been working hard on her research project, titled “Frequency and Associated Imaging Features of Malignancy for Foci of Enhancement (FOE) on Breast MRI.”

“MRI currently stands as the most sensitive tool for breast cancer screening, which is one of the most effective tools of early detection of breast cancer,” Dr. Tiong explains. “However, with cancer presenting as an enhancing mass or areas of non-mass enhancement in the breast, the specificity is variable. While interpreting MRI, foci of enhancement (FOE) – small, isolated dots that are generally less than five millimetres in size, can pose a diagnostic dilemma when considering the malignancy of FOE.”

With literature offering insights into the malignancy of FOE often scarce and inconclusive, exhibiting malignancy rates of less than 1 per cent to 12.5 per cent with limited sample sizes, Dr. Tiong wanted to take a closer look. With the objective of determining malignancy rates for FOE seen on breast MRI after MRI-guided biopsy, Dr. Tiong has set out to identify clinical and imaging features that can serve as predictors of malignancy for FOE.

“Conducting MRI-guided biopsies is an expensive process and can be long and uncomfortable for patients,” says Dr. Tiong. “With this in mind, myself and my team are working to demonstrate that if the malignancy prevalence of MRI-detected FOEs is less than two per cent – aligning with a BI-RADS category 3 lesion – these can be addressed with follow-up MRI to confirm stability and avert the need for unnecessary MRI-guided biopsies.”

On the other side, Dr. Tiong explains that if malignancy rates prove to be higher, biopsy recommendation would be more justified, and therefore offset patient stress and anxiety related to the invasive procedure, as well as justify the higher costs associated with it.

Dr. Tiong will be continuing this research with the study aimed at wrapping up in March of 2024.