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Special report: Tackling the dense breast dilemma

by Loren Bonner, DOTmed News Online Editor | May 21, 2012
From the May 2012 issue of HealthCare Business News magazine

The cost of a breast MRI has been considered a drawback. But Kinsella explains that breast MRI procedures are typically covered by insurance plans when the modality is used for the correct patient, for example, the high-risk patient, or for diagnostic purposes.

"We are also seeing some plans covering breast MRI for women with mammographically dense breasts," she says.

Although ACS does not recommend a screening ultrasound for women at high risk, it’s an attractive alternative for those who don’t want an MRI. In an email to DOTmed Business News, Dr. Phil Evans, immediate past president of the Society of Breast Imaging, said “Over 40 percent of high risk women in the ACRIN 6666 trial offered an MRI declined although the exam was at no cost. The most common reason was claustrophobia.”

In many ways, ultrasound is a more accessible technology than MRI, and it’s usually used in the diagnostic phase, once mammography has indicated there’s something more to investigate.

However, published studies — like ACRIN 6666 — using ultrasound and mammography have reported high false positive rates. This can generate a lot of unnecessary biopsies, and it raises questions about what’s in the best interest of the patient.

Some companies have maneuvered around this problem. SuperSonic Imagine, an ultrasound technology company based in France, has an added tool that the company hopes will reduce the number of false positives in breast ultrasound screening. ShearWave Elastography provides information on tissue stiffness, data which is not available on conventional ultrasound.

“We think ShearWave Elastography can play an important role in reducing false positives when screening with ultrasound. ShearWave Elastography is like an electronic palpation, it ‘feels’ the organ with the technology,” says Michele Debain, global marketing director for SuperSonic Imagine. Reproducible and based in science, ShearWave Elastography computes the speed of (inoffensive) shear wave movement through tissue. “The speed of the shear wave is directly related to the stiffness of the tissue and the stiffer the tissue, the more likely it will be a pathology,” she says.

Reports have recently emerged showing that Breast-Specific Gamma Imaging, also known as Molecular Breast Imaging, can also be useful in identifying cancer in women with dense breasts.

“When you look at cancer in dense breasts with mammography, it’s like a small cloud in a big cloud,” says Pjerin Luli, marketing and product manager at Dilon Technologies, Inc. “It’s different in molecular breast imaging because it looks into the molecular activity, the density doesn’t matter.” Dilon’s Gamma Camera gives doctors a clearer picture of which tissue is benign and which is malignant. The tracing agent absorbed by cells in the body allows the doctors to look into the regions that have high molecular activity, which tells them it’s a cancer region because the molecules are multiplying faster, sucking in more liquid and appearing darker on the image.

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