Detecting, Diagnosing Breast Cancers


14 april 2008-- New studies into breast cancer imaging techniques reinforce the importance of these procedures in detecting and treating tumors in the young and the elderly.
The findings, all expected to be presented during the American Roentgen Ray Society's annual meeting this week, in Washington, D.C., include:Evaluating palpable breast lesions by using mammography and sonography helps rule out cancers in most patients. MRIs are effective at showing how the blood flows to and from certain breast tumors, a critical fact in determining treatment planning and prognosis. An MRI given before initial surgical treatment resulted in 28 percent of breast cancer patients having their treatment changed. Women over age 70 can still benefit from mammograms even though some guidelines do not recommend the need for the exam.
Mammography and sonography
Researchers at Baystate Health in Springfield, Mass., showed that when mammography and sonography are combined, they are 98 percent effective in ruling out cancers in most patients.
In evaluating 414 palpable breast lesions using both imaging techniques, 118 lesions were correctly viewed as negative after three years of patient evaluation, which included 28 patients having biopsies, according to the study. Two other original negative findings, though, proved to be false negatives with malignancies later being confirmed.
The two false-negative lesions "became increasingly suspicious on clinical exam and later became apparent by imaging," study author Dr. Erica Tyler said in prepared statement. One false-negative occurred in a patient with heterogeneously dense tissue and was diagnosed more than six years after initial clinical discovery. The second false-negative lesion o ccurred in extremely dense tissue and was diagnosed almost seven years after initial discovery.
"Uncommonly, palpable malignancies may not be detectable on both mammography and sonography, and this combination of imaging doesn't rule out malignancy," Tyler said. "Also, based on our findings, long-term clinical and imaging follow-up of over five years may be needed to diagnose all palpable cancers, when the initial mammogram and sonogram are unrevealing," she said.
Use of MRI
Two studies confirm the effectiveness of a patient receiving an MRI before finalizing treatment.
The first, done by Yale University School of Medicine researchers, showed that more than a quarter of 110 breast cancer patients who had an MRI before breast surgery ended up making changes in their treatment plans as a result.
"MRI prompted biopsy of 70 sites in 44 patients," study author Dr. Carol Lee, now at Memorial Sloan-Kettering Cancer Center in New York City, said in a prepared statement. Sixteen additional cancer sites were found in 13 women, or 12 percent, she said.
Surgical treatment was changed in 31 cases (28 percent), such as opting for mastectomy rather than lumpectomy or a more extensive lumpectomy than first expected. Three also found cancer in the other breast that was treated.
"Breast MRI is a very useful tool for assessing extent of tumor in the breast, however, there are downsides that need to be taken into consideration," Lee said. This includes treatment delay, which was 41 days between diagnosis and treatment for MRI patients compared with 27 days for the patients who did not undergo the imaging, she said.
The second study, conducted by researchers at the University of Miami in Florida and the Rabin Medical Center in Petah Tikva, Israel, found that an MRI clearly differentiates the blood supply to medial and lateral breast tumors. This aids in determining a course of treatment and making a prognosis.
"MRI is currently the best modality enabling us to visualize not only cancer in the breast but the effect it has on the surrounding anatomy, especially regarding vascular supply and lymphatic drainage," lead author Dr. Ahuva Grubstein of the Rabin Medical Center said in a prepared statement.
"Our findings support existing differences between medial and lateral breast tumors regarding metastatic spread and survival. These differences may indicate a need for differential treatment modalities according to location," Grubstein added.
Screening for the elderly
With guidelines for mammography screening in the elderly in some flux, a study of 24 patients -- aged 70 to 89 -- found frequent mammograms can still aid in early breast cancer detection.
"During our study, we found that five patients never had a prior mammogram. Their breast cancer was detected on a baseline study. These five patients included three cases of infiltrating ductal carcinoma," lead author Dr. Jason Salsamendi of the Jacobi Medical Center and Albert Einstein College of Medicine in Bronx, N.Y., said in a prepared statement. "Perhaps with more frequent mammographic screening, more breast cancers can be found earlier, at a noninvasive stage. This would result in a less extensive surgical procedure and improve prognosis. Our results encourage clinicians to continue to order screening mammography in elderly patients at yearly intervals."
According to the study, 19 of the 24 cases of breast malignancy were initially identified on screening mammography. The study also showed that the average time interval from most recent prior mammogram to diagnosis was 2.6 years.