When breast cancer is diagnosed, doctors usually perform other tests to figure out exactly how large the cancer is, as well as whether the tumor has spread. You and your doctor will use this important information to decide on the best treatment for your unique situation. The study reviewed here found that an imaging technique called breast specific gamma imaging can help doctors identify cancer lesions weren't seen on the original mammogram.
Breast specific gamma imaging also is known as molecular breast imaging, Miraluma, sestamibi, or scintimammography. A small amount of the molecule sestamibi that has been tagged with a radioactive substance (technetium 99) is injected intravenously. Breast cancer cells tend to take up the tagged sestamibi molecule much more than normal cells. A nuclear medicine scanner -- also called a gamma camera -- then scans the breast and looks for any areas where the radioactive substance is concentrated, suggesting breast cancer.
About 160 women who had been diagnosed with breast cancer with a biopsy participated in this study. All the women had breast specific gamma imaging after the biopsy but before any treatment was planned or started. The breast specific gamma imaging was to look for signs of any cancer besides what was identified in mammograms.
The breast specific gamma imaging found 56 other breast abnormalities that weren't in the mammograms. Biopsies were done on 45 of the abnormalities and 14 of them were found to be cancer. Nine of these new, additional cancers were in the same breast as the original cancer and five were in the opposite breast. Half of these cancers were very small (less than 1 centimeter), so it's not surprising these cancers weren't seen on the mammograms.
If you've just been diagnosed with breast cancer, you'll understandably want your treatment to begin right away. Still, getting all the information you can about your specific situation BEFORE treatment starts is the best way to make sure that the decisions you and your doctors make are the very best for your situation. Breast specific gamma imaging is becoming somewhat more available, but it's not available everywhere yet. Your doctor may recommend other imaging techniques -- such as MRI or ultrasound -- after breast cancer is first diagnosed, but before the treatment plan is finalized. Waiting for more test results may make you more anxious, but in the long run that additional information will give you and your doctor confidence that your treatment decisions were well-informed and are the best for YOU.
CHICAGO, Dec. 3 (MedPage Today) -- In women newly diagnosed with breast cancer, a follow-up study with breast specific gamma imaging detected additional lesions missed by mammography and physical exam.
Moreover, because the additional malignancies were identified before therapy was initiated, "breast specific gamma imaging provided information that determined important differences in therapy," said Rachel F. Brem, M.D., of the Breast Imaging and Interventional Center at George Washington University Medical Center in Washington.
The findings came from a retrospective study of 159 women reported by Dr. Brem at the Radiological Society of North America meeting here.
Unlike mammography, which relies on breast structure to identify cancers, breast specific gamma imaging tracks the uptake of a radiotracer (Technetium Tc99m Sestamibi) by breast cancer cells.
A gamma camera tracks the radiotracer and lesions are identified on a digital image.
"The woman is imaged while sitting in a very comfortable position, the entire test takes about 40 minutes, and the results can be read immediately," Dr. Brem said.
She noted that the unit costs about $250,000 and the radiotracer costs about $75 per imaging study.
"This is a very cost-effective molecular imaging modality," she said.
The 159 women, ages 29 to 93, had at least one biopsy-proved breast cancer.
Of the participants, 39% were premenopausal, 12% had a history of breast cancer, and 43% had a first degree relative with breast cancer, Dr. Brem said.
"Interestingly, 73% of these women had dense breast tissue, which made detection by mammogram difficult," she said.
Using breast-specific gamma imaging, Dr. Brem and colleagues detected 56 additional areas of abnormalities, 45 of which were biopsied.
They detected 14 malignancies in the 45 biopsies. "These were all cancers that went undetected before breast specific gamma imaging," Dr. Brem said.
Nine of the cancers were in the same breast as the incident lesion -- and in at least one case the location of the second lesion meant that a woman originally slated for lumpectomy required mastectomy.
The remaining five lesions were in the contralateral breast.
Half of the cancers were less than 1 cm in diameter, a size unlikely to be detected with mammography.
Dr. Brem said that breast-specific gamma imaging has been approved since 1999 and is currently available in about 50 centers in the U.S.
Mary Mahoney, M.D., of the University of Cincinnati and a discussant at the session where the study was presented, said the data confirm the utility of breast specific gamma imaging as part of a "growing number of molecular imaging modalities that allow us to detect ever smaller lesions. In this case, use of this technique helped guide therapy."
Dr. Brem disclosed that she owned stock in Dilon Technologies and is a board member of Dilon, which makes the breast specific gamma imaging unit. She also said she has served as a member of the board of directors of iCAD Inc., and was a consultant for Orbotech.
Dr. Mahoney disclosed that she is a consultant to Johnson & Johnson and SenoRx.
Primary source: Radiological Society of North America Source reference: Brem RF, et al "Breast specific gamma imaging in women with one suspicious or cancerous breast lesion" RSNA 2008; SSM01-05.
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