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The Radiological Society of North America (RSNA) released recent findings on treatment for breast cancer at its annual meeting in Chicago, IL this week.

New Imaging Technology
Study information was released using positron emission mammography (PEM), a new technique for imaging the breast that works in spite of dense tissue or hormones. Two advantages are that the exam is performed while the patient is seated, and there are only 48 images to review as opposed to 2,000 with an MRI.

"The ability of PEM to detect cancer does not appear to be adversely affected by breast density, hormone replacement therapy or menopausal status," said lead researcher Kathy Schilling, M.D., director of breast imaging and intervention at the Center for Breast Care at Boca Raton Community Hospital in Florida. "The sensitivity of PEM is equal to or better than breast MRI, and PEM has fewer false-positive results."

Results showed that in 208 patients, PEM rated 93 percent in detecting cancer. PEM successfully detected cancer in 100 percent of fatty breasts, 93 percent of dense breasts, 85 percent of extremely dense breasts, 93 percent of women both with and without a history of hormone replacement therapy, 90 percent of pre-menopausal women and 94 percent of post-menopausal women.

Dr. Schilling explained that PEM is ideal for those patients whose MRI is difficult to interpret, women with implants, patients with metal in their bodies, or patients who suffer from claustrophobia.

BSGI

Another emerging imaging treatment effective in detecting cancers not found with mammograms or clinical exams is breast-specific gamma imaging (BSGI). A mammogram shows normal and suspicious breast tissue, but BSGI findings are based on cancerous cell physiology. It is meant as an adjunct to a mammogram.

"BSGI can identify the most difficult to detect breast cancer--invasive lobular carcinoma," said lead author Rachel F. Brem, M.D., professor of radiology and director of the Breast Imaging and Interventional Center at The George Washington University Medical Center in Washington, D.C.

BSGI uses a high-resolution gamma camera that allows for imaging with very mild compression of the breast along with an injection of a low-dose nuclear radiotracer, which is absorbed by the cells. Because cancerous cells have a higher rate of metabolic activity, the tracer is taken up by these cells at a higher level than in normal cells.

The study included records of 159 women with at least one suspicious or cancerous lesion found by mammography or physical exam who had undergone BSGI to determine if additional lesions were present. Additional lesions were reported in 29 percent of the women, and of those who underwent a biopsy, 39 percent discovered the lesions were cancerous.

"The data suggest that BSGI allows for the diagnosis of more and earlier breast cancers," Dr. Brem said.

Special Therapies
A study also released at RSNA introduced a new cancer therapy for women who have had breast augmentation. It involves a partial-breast radiation treatment called brachytherapy, and it is reported to provide improved cosmetic outcomes.

The most common treatment for patients with cancer and breast implants is mastectomy and implant exchange. While whole-breast radiation therapy after a lumpectomy is an option, it presents a risk of scar tissue wrapping around the implant, causing it to become rock-hard, visually-distorting and extremely painful.

"We are seeing an increasing number of breast cancer patients with augmentation," said Robert R. Kuske Jr., M.D., clinical professor at the University of Arizona Health Sciences Center and radiation oncologist at Arizona Oncology Services in Scottsdale, Ariz. "By nature, these women are concerned about their appearance and we need to have options for them."

Breast brachytherapy involves radioactive "seeds" which are guided into place through catheters, with the aid of imaging and a computer. The seeds emit high doses of radiation in short bursts. Recovery time is significantly reduced as well.

For the study, 65 women who were diagnosed with small, early stage malignant tumors were treated with brachytherapy after a lumpectomy. The women received two doses per day, at intervals for five days. None of the patients experienced tumor recurrence during the follow-up period. Cosmetic outcome was determined to be good to excellent in 100 percent of patients with 95 percent judged excellent. Implant hardening was not observed in any of the patients.

"Compared to traditional treatments, brachytherapy offers an excellent alternative for these women," Dr. Kuske said. "It offers very high rates of tumor control with fewer side effects and is easier on their lifestyle."

For more information on these technologies and treatments, see the links below.
http://www.rsna.org/media/pressreleases/pr_target.cfm?ID=382
http://www.rsna.org/media/pressreleases/pr_target.cfm?ID=391
http://www.rsna.org/media/pressreleases/pr_target.cfm?ID=390