From the July 2016 issue of HealthCare Business News magazine


A recent study at Chang Gung Memorial Hospital and Medical College of Chang Gung University in Taiwan, published in Diagnostic Imaging Europe last November, showed that contrast-enhanced mammography was more sensitive and more specific than MRI in evaluating indeterminate breast calcifications for malignancy.

While contrast-enhanced mammography is as sensitive but more specific than MRI, according to Leong, it is a newer technology and not as established as MRI.


A weakness of contrast-enhanced mammography, just as with conventional mammography, is that lymph nodes in the axilla are not completely visualized because it is difficult to pull the tissue in the axilla into the mammogram, according to Leong. “I ultrasound the axilla for all positive CEDM studies to completely evaluate the axilla for abnormal lymph nodes,” Leong says. “We have found several cancerous lymph nodes in the axilla that were not seen by CEDM or mammography.” Besides a lack of expensive MRI equipment, facilities also find it difficult to get pre-approval for MRI exams from insurance companies. “If [contrast-enhanced mammography] had come out first, I think it would have been hard for MRI to make a go of it,” Leong says.

MBI in place of MRI
Molecular breast imaging has also emerged as an alternative to MRI for women with dense breasts. Researchers at the Mayo Clinic published a study last year in the American Journal of Roentgenology that showed using molecular breast imaging detected nearly four times as many invasive cancers as digital mammography in women with dense breast tissue.

The ProMedica Breast Care radiology practice in Toledo, Ohio, recommends a supplemental MR scan for patients with a lifetime risk of at least 20 percent for developing breast cancer and who have dense breast tissue. But, for non-high-risk patients with dense breasts, or for those women who can’t undergo MRI because of a pacemaker or because they suffer from claustrophobia, they recommend screening with MBI. Ohio is one of more than two-dozen states with a breast density notification law, which requires physicians to notify women who have dense breast tissue.

ProMedica has Gamma Medica’s LumaGEM MBI system, which uses the technetium-99m sestamibi radiopharmaceutical and employs a dual-head digital detector and a special collimator. Dr. Robin Shermis, medical director of ProMedica Breast Care, says data in a paper he authored with others that was recently accepted by the American Journal of Roentgenology show that screening with MBI is capturing eight additional cancers per 1,000 women screened and has a sensitivity and specificity that approaches MRI. MBI is also a fraction of the price of an MRI and slightly more than a tomosynthesis examination, he says.

July 2016 Magazine

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