October 20, 2015 | by Abe Rosenberg
A new spin on a tried-and-true imaging system could potentially provide more women with superior breast cancer detection at a lower cost.
Although 2-D and, more recently, 3-D digital mammograms (also called tomosynthesis) have been the standard for general breast cancer screening, many experts recommend supplementing the mammogram with a breast MRI (magnetic resonance imaging) for women at higher risk. Patients who've already been diagnosed with the disease typically also undergo an MRI to help pinpoint the location and size of the tumors.
But MRIs are expensive, as much as 10 times the cost of a mammogram. Also, MRI machines are not always widely available, and many women, including those who are elderly, claustrophobic or obese, cannot easily tolerate the 60- to 90-minute procedure. Some patients with metallic implants like pacemakers or artificial joints should avoid MRIs altogether.
One City of Hope radiologist has come up with an alternative.
Nikita “Nikki” Gidwaney, M.D., suggests replacing breast MRIs in select cases with 3-D mammograms enhanced with added contrast. Gidwaney hopes to conduct trials which will demonstrate that contrast-enhanced breast tomosynthesis, or CEBT, can deliver equally precise results while avoiding MRIs’ high cost and inherent limitations.
“Breast MRIs have a very high false-positive rate,” says Gidwaney, assistant clinical professor in the Department of Diagnostic Radiology. “That leads to unnecessary biopsies and elevated patient anxiety. I think we can achieve a lower false-positive rate with CEBT.”
The next logical step
Gidwaney's idea evolved from observing the steady improvement in 2-D digital-imaging technology, especially when iodine contrast is introduced. The next logical step, she and others believe, is to do the same with the 3-D tomosynthesis machine, using software already available from the manufacturer.
One possible drawback to Gidwaney's approach is the added radiation of tomosynthesis, compared to MRIs. But Gidwaney says the actual amount of additional radiation is minimal, far lower than radiation levels of CT (computed tomography) and PET (positive emission tomography) scans, and even smaller than the normal background radiation we all encounter in our daily lives. “We use much more radiation with other cancers,” she says. “And in this case, without a doubt, the benefits far outweigh the risks.”
“It's an awesome idea,” says Laura Kruper, M.D., head of breast surgery service. “I think (Dr. Gidwaney) is onto something here. If CEBT is found to be equivalent to MRI for documenting the extent of the disease with fewer false positives, this would be wonderful.” Along with Joanne Mortimer, M.D., director of the Women's Cancers Program, Kruper is enthusiastically helping Gidwaney take this project forward.
Gidwaney is grateful for the vote of confidence.
“It's been such a positive experience,” she says, “getting so much support from my colleagues, seeing how the clinicians are so excited by the project. I really appreciate that. We're a real team here, always pulling for each other, and always for the sake of the patient. It's what brings us to City of Hope in the first place, and what keeps us working 11, 12 hours a day. We want to be here.”
Better health for all women
But Gidwaney also wants something more.
She is both physician and activist, a radiologist not content to just “sit in a dark room” interpreting images. Having switched to radiology from pediatrics, Gidwaney makes a point of forging deep connections with her patients. “That's my favorite part of the job,” she says. She also advocates for women's health around the world and recently returned from a speaking engagement in India where medical technology is comparable to Western standards, but cultural awareness of the need for widespread screenings is “30 years behind everyone else.”
Finding a more efficient, less expensive imaging alternative is a natural outgrowth of the way she views her mission.
“We've come so far from the early days of imaging,” she says. “My goal is to encourage progress, so that an idea or technique that now may seem drastic and 'out of the box' will one day become just another available tool that can help more people.”
Find out more about City of Hope's Breast Cancer Program. Learn more about our unique patient experience, how to make an appointment or get a second opinion at City of Hope. You may also request a new patient appointment online or call 800-826-HOPE (4673) for more information.