New imaging technique gives further hope in battle against breast cancer

New imaging technique as shown on a screen
November 5, 2018

A technique which could help more effectively detect the presence of breast cancer in Australian patients and is being trialled at Royal Perth Hospital (RPH) was outlined at The Royal Australian and New Zealand College of Radiologists’ Annual Scientific Meeting recently.

Contrast Enhanced Spectral Mammography (CESM) can allow a radiologist to detect more breast cancers than standard scans such as mammography and ultrasound alone, while providing a quicker and more accurate imaging tool for these potentially life-threatening cancers.

CESM involves injecting patients with an iodine-based dye prior to breast imaging to produce both a standard mammogram and images showing areas of abnormal iodine uptake in breast tissue. This gives the radiologist high-resolution structural information as well as functional information about areas that contain high levels of abnormal blood vessels, as often occurs in breast cancers.

On standard mammography, some cancers in women with dense breasts can be hidden in the surrounding normal tissue. The use of CESM can overcome this, as cancers are displayed as white areas against a grey background of normal tissue.

Studies have shown that the accuracy of CESM for assessing the extent of breast cancer is similar to that of breast MRI. Performing and reading CESM exams is easier than breast MRI, with no special training needed for radiographers and radiologists who are already undertaking standard mammography.

RPH Breast Clinic’s Clinical Associate Professor Donna Taylor, has been leading a study assessing CESM’s effectiveness and said the technique has many advantages over traditional imaging methods.

“Breast cancer is the most commonly occurring cancer in women and the second most common cancer overall, with an estimated two million new cases worldwide expected this year,” A/Prof Taylor said. “Imaging plays a vital role in the diagnosis and treatment of breast and other cancers.

“To ensure best treatment, the surgeon needs to know exactly how big and where the tumour is in the breast. MRI is a very sensitive test to show breast abnormalities, however not all of these findings will be due to cancer, which means we need to do further needle biopsies to avoid over-treatment. CESM is almost as sensitive as breast MRI but has fewer of these ‘false positive’ tests.

“CESM has many other advantages over MRI. For optimal results, breast MRI usually needs to be scheduled according to a woman’s menstrual cycle. CESM can, however, be performed at any time in the cycle and can usually be done while the woman is still in the clinic.

“Performing a CESM only takes about eight minutes, while a breast MRI can take about 40 minutes,” she said. With the use of CESM, patients spend less of their time in the clinic, so they can get on with their lives.”

More than 18,000 Australian women – 49 a day – are expected to be diagnosed with breast cancer in 2018. Given the limited access to breast MRI in Australia, and the limited current indications for a Medicare rebate, the use of CESM could provide Australian women with access to a simple, quick and relatively cheap tool that has similar diagnostic accuracy.

A/Prof Taylor and her colleagues have also found that women prefer the experience of CESM over MRI.

“The results of one of our cancer staging studies found that when told the tests had similar accuracy, women who had undergone both CESM and MRI showed a significant preference for CESM,” A/Prof Taylor said. “In our experience, CESM is an extremely helpful problem solving tool that we perform on an almost daily basis.

“There could be a possible abnormality on a screening mammogram - for example, particularly in those women who have dense breasts and where the appearances on ultrasound are complex. If the CESM is normal, the likelihood of a significant abnormality being present is very low, which is very reassuring for both the doctor and patient.

“We also use it to help us decide which areas in the breast we need to biopsy and to help us identify the local extent of disease in women with a known breast cancer.

“We believe CESM provides us with another vital tool to help radiologists detect and guide the best treatment for women with breast cancer. It also underlines the vital role imaging plays in the diagnosis and treatment of many other potentially life-threatening cancers.”