Women's Imaging News

In a large screening study at the Hospital of the University of Pennsylvania (HUP), researchers compared breast imaging results from 3-D mammography, known as digital breast tomosynthesis, to results from standard digital mammography, which is the most widely used breast cancer screening procedure of today. Tomosynthesis allows for 3-D reconstruction of breast tissue, giving radiologists a clearer view of the overlapping slices of breast tissue. Additionally, this seemingly new technology may soon lead to an improved detection for breast cancer with fewer callbacks for false positives. For the study, approximately 15,600 women received 3-D mammography, and around 10,700 had standard digital mammograms. Six radiologists looked at the images and determined that the 3-D mammograms found 22 percent more breast cancers and led to fewer callbacks (10.4 percent for standard mammography as opposed to 8.78 percent for 3-D mammography). “It’s the most exciting improvement to mammography that I have seen in my career, even more important than the conversion from film-screen mammography to digital mammography. The coming years will be very exciting as we see further improvements in this innovative technology,” said chief of breast imaging in the radiology department at the Perelman School of Medicine at the University of Pennsylvania, Emily F. Conant, M.D. Results of the study were presented by Conant at the annual meeting of the Radiological Society of North America held earlier this month in ... Read more

In a study of screening mammography-detected breast cancers, patients who had more common screening mammography had a considerably lower rate of lymph node positivity, or cancer cells in the lymph nodes, as opposed to women who went through longer periods between screening mammography exams. Results of the study were presented at the annual meeting of the Radiological Society of North America (RSNA). In its earliest stages, breast cancer is restricted to the breast and can be treated by surgical excision of the cancer cells. As the disease progresses, breast cancer cells may metastasize and spread to the lymph nodes and then to other parts of the body. "On its pathway to other places in the body, the first place breast cancer typically drains into before metastasizing is the lymph nodes. When breast cancer has spread into the lymph nodes, the patient is often treated both locally and systemically, with either hormone therapy, chemotherapy, trastuzumab or some combination of these therapies,” said assistant professor of radiology at Northwestern University/Feinberg School of Medicine in Chicago, Ill, Lilian Wang, M.D. Historically, healthcare organizations, such as RSNA and the American Cancer Society (ACS), have recommended annual screening with mammography for women starting at the age of 40. Yet, in 2009, the United States Preventive Services Task Force (USPSTF) announced a contentious new recommendation for biennial screening for women between the ages of 50 and 74. "Our study looks at what would happen if the revised guidelines issued by USPSTF were followed by women,” said Wang. The retrospective study, carried out at Northwestern Memorial Hospital, included 332 women with breast cancer detected by screening mammography between 2007 and 2010. The women were separated into one of three groups, predicated on the length of time between their screening mammography exams: less than 1.5 years, 1.5 to three years and more than three years. There were 207, 73, and 52 patients in each category, respectively. Controlling for age, breast density, high-risk status and a family history of breast cancer, the researchers assessed that women in the less than 1.5-year interval group had the lowest lymph node positivity rate at 8.7 percent. The rate of lymph node involvement was notablly higher in the 1.5- to three-year and over three-year interval groups at 20.5 percent and 15.4 percent, respectively. "Our study shows that screening mammography performed at an interval of less than 1.5 years reduces the rate of lymph node positivity, thereby improving patient prognosis. We should be following the guidelines of the American Cancer Society and other organizations, recommending that women undergo annual screening mammography beginning at age 40,” Wang ... Read more

A new clinical trial for breast cancer, recently published in The Lancelot, demonstrates that a single fraction of targeted intraoperative radiotherapy (TARGIT) administered with the ZEISS INTRABEAM® at the time of lumpectomy is in no way inferior to standard external beam radiation (EBRT) delivered over three to six weeks following breast conserving surgery, for a select group of patients. “The most important benefit of TARGIT for a woman with breast cancer is that it allows her to complete her entire local treatment at the time of her operation, with lower toxicity to the breast, the heart and other organs. Our research supports the use of TARGIT concurrent with lumpectomy, provided patients are selected carefully, and should allow patients and their clinicians to make a more informed choice about individualizing their treatment, saving time, money, breasts, and lives," said Professor Jayant S. Vaidya, FRCS MD, PhD from the international TARGIT investigators group. Since 1998, the international TARGIT research group has explored whether radiotherapy targeted to the tumor site at the time of surgery can reduce the risk of recurrence in early breast cancer as efficiently as the standard three to six week EBRT. Customarily, whole-breast EBRT is given following lumpectomy (breast conserving surgery) to reduce the risk of recurrence of cancer in the breast and of breast cancer mortality. EBRT usually is administered over a course of three to six weeks requiring patients to receive treatment at radiotherapy centers for 20-30 days. In some cases, women eligible for breast conserving surgery, but residing quite a distance from a radiotherapy center and unable to attend daily post-surgical treatments may even undergo mastectomy as a second option. In the TARGIT technique, during surgery following excision of the tumor, the affected tissue in the tumor site is irradiated from within the breast using the ZEISS INTRABEAM. The TARGIT study results reveal that targeted intraoperative radiotherapy delivered with ZEISS INTRABEAM can significantly reduce the risk of recurrence of the cancer as successfully as a standard three to six week course of whole breast irradiation in selected women with invasive ductal carcinoma. The TARGIT-A trial has been noted to be the largest multicenter randomized clinical trial for intraoperative radiotherapy (IORT) in the field of partial breast irradiation, with 3,451 patients in 33 international centers across Europe, the United States, and Australia. The TARGIT-A trial followed an individualized risk-adapted approach, meaning, that patients who had undergone TARGIT at the time of surgery showed in the final pathology additional unexpected risk factors, were given supplemental EBRT, which was the case for around15% of the patient population. The 5-year results for local recurrence and the first analysis of overall survival of the TARGIT-A trial have now been reported. When comparing TARGIT with EBRT the difference in 5-year local recurrence between the two treatments was less than 2.5% and consequently considered "non-inferior" to standard EBRT (daily doses for 3-6 weeks) in treating the cancer. Overall mortality was 3.9% with TARGIT and 5.3% with EBRT, due to fewer deaths from cardiovascular causes and other cancers. "TARGIT concurrent with lumpectomy within a risk-adapted approach should be considered as an option for eligible patients with breast cancer carefully selected as per the TARGIT-A trial protocol,” the study authors eventually concluded based on the statistical information of breast cancer recurrence, number of deaths, and side effects of TARGIT vs. EBRT. "We commend the international TARGIT group pioneered by Professor Jayant Vaidya and Professor Michael Baum for this outstanding research on this new treatment option that can benefit many breast cancer patients. The TARGIT group's research will further enhance adoption by radiation oncologists and breast surgeons worldwide and will broaden the application of our ZEISS INTRABEAM for this new option in the fight against cancer," said President and CEO of Carl Zeiss Meditec AG, Dr. Ludwin Monz ... Read more

eRAD has recently announced the release of its new, enhanced, FDA approved mammography module with a full feature set for breast imaging and integration with eRAD PACS. With this product, eRAD, a subsidiary of RadNet, Inc, a leading provider of standards-based, web-centric radiology image and data management solutions, removes the need for a dedicated mammography workstation and provides considerable strives in effectiveness for radiologists. “What should be a simple action, say, viewing calcifications on an ultrasound for comparison, should not require a separate workflow. We have it integrated. There is no need to switch to a different workstation, with a different monitors and layout, to call up another worklist in disparate system, and then try to find the patient and the related prior. All of that back-and-forth is a time, money, and resource drain that eRAD can eliminate,” said Senior VP of Sales for eRAD, Seth Koeppel. “eRAD enables multiple modalities; CT, ultrasound, MRI, mammography, tomosynthesis, to be viewed side-by-side on the same workstation from anywhere, whether reading from the LAN or WAN. We enable radiologists to read and report out of the same system, and that solves cost and workflow issues,” he added. eRAD technology is built to handle the storage capacity, archive costs, and distribution infrastructure necessary to support tomosynthesis, allowing imaging groups to provide this novel modality to patients and find early curable breast cancers. With an eRAD solution, comparison studies, priors for that day's appointments, for example, can be pre-staged on a specific workstation for faster reads, even if those studies are archived in a third-party system. Productivity gains are achieved not only by multi-modality reads from the same workstation but also with features designed specifically for breast imaging workflow, such as industry standard pre-set mammography layouts; mirrored image linking; anatomical grayscale inversion; tomo cine; and configurable keyboard, mouse, and keypad macros which enable users to further customize and replicate the behavior of a dedicated workstation. Skin-line detection enables users to auto-position a full resolution image according to anatomy or image area. Flexible custom layouts can be set to initialize together so users can toggle quickly between multiple views. eRAD's Mammography Module also provides advanced diagnostic tools. Along with CAD support (with configurable archiving for CAD objects) and image manipulation tools, eRAD offers the optional AIE Image Enhancement Module to aid in visualizing and assessing subtleties in digital mammograms. Accuracy is much improved by AIE's sophisticated processing algorithms, which enhance the clearness of abnormalities in dense breast tissue. Integrated mammography tracking is accessible and offers another uptick in effectiveness as well as a way of building and strengthening patient relationships. "Every minute counts, that's the way we see it. We're an enterprise workflow engine, so we're focused on how to help radiologists read more, faster, from anywhere, while maintaining a high degree of accuracy. The eRAD Mammography Module is another example of how we strive to automate the business and clinical workflow of medical imaging,” said ... Read more

Based on two new studies, a growing number of American women are receiving breast magnetic resonance imaging (MRI) as a means to screen for cancer. However, there are still some concerns that expensive MRIs are not being utilized among the numbers of women who would benefit the most from this imaging system. "It's a great new test but no one had looked at how and if it was really used. These are the first studies to really document the use and rates of use for breast MRIs,” said assistant professor in the Department of Population Medicine at the Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, and who led one of the studies, Natasha Stout. “In addition to not exposing women to radiation MRIs are known to be more sensitive and show more small abnormalities than traditional mammograms. But that also means more false alarms that result in biopsies,” said chief of breast surgery at Duke University in Durham, North Carolina, co-wrote an editorial accompanying the new studies published this week in JAMA Internal Medicine, Dr. Shelley Hwang. Both the American Cancer Society and the National Comprehensive Cancer Network suggested breast MRIs be employed in accordance with mammograms among women who present a lifetime breast cancer risk of 20% or higher, usually due to their family history. Stout's team examined MRI tendencies at two healthcare systems in the northeastern U.S. from 2000 to 2011. The group acquired data from 10,518 women who were 20 years old and older and had at least one breast MRI. Another group, led by Karen Wernli at Group Health Research Institute in Seattle, utilized data from five different U.S. breast cancer registries from 2005 to 2009. Their set of data featured information on 8,931 breast MRIs and about 1.3 million mammograms performed on women between 18 and 79 years old. Both teams eventually found that breast MRIs have become more widespread. Stout and her team noted an increase from less than one breast MRI for every 1,000 women in 2000 to 10 breast MRIs per 1,000 women in 2011. Wernli's team discovered the use of breast MRIs increased from about four per 1,000 women in 2005 to 12 per 1,000 women in 2009. "The main motivation behind this study has been that while there has been an increased use of breast MRI, no one has been able to determine why there was an increase in breast MRI use," said Wernli. What her group found was that around 40% of breast MRIs were being employed to help make a diagnosis following another test or observation. About 32% were used for screening. Wernli's team also found the quantity of MRI-screened women who met the cutoff for a high risk of breast cancer increased during the study. yet, only 5% of high-risk women were screened with MRI and they made up just one-quarter of women who were screened that way. Hwang and her co-author Dr. Isabelle Bedrosian from the MD Anderson Cancer Center in Houston wrote that the data "indicate the need for better patient selection for breast MRI screening." Both studies illustrated the use of breast MRIs balanced out after 2008. Hwang told Reuters Health this may reveal that doctors were quick to apply the new technology however doubled back on its use once organizations put out their recommendations. "It wasn't really until the guidelines came along when people started dialing back on using them in the less beneficial situations," she said, adding that more research is in progress to see if breast MRIs are also beneficial in diagnosing breast cancers. Stout told Reuters Health it will be important to continue looking at how many women are receiving breast MRIs and why. "I think monitoring this going forward is important to make sure we're using this expensive technology wisely," she said. Hwang also mentioned a mammogram usually costs about $300. However, a breast MRI can cost between $700 and $1,200, depending on where women ... Read more

Based on a new study published online in the journal Radiology, breast biopsies can negatively affect short-term quality of life with the effects being especially prominent in younger patients. Records show that over 500,000 women in the United States have a breast biopsy on an annual basis. In the percutaneous approach, a physician uses a needle to remove numerous small samples from the area of interest for pathological analysis. Percutaneous biopsies are linked with fewer complications than the surgical method, yet there are still apparent short-term side effects, including pain and emotional distress. "Short-term experiences can have a long-term impact. If people have a less than positive experience during biopsy, then they might be less likely to come back for screening the next time they are due,” said former staff radiologist at Massachusetts General Hospital (MGH) in Boston and assistant professor at Harvard, Janie M. Lee, M.D., M.Sc. To better understand the effects of percutaneous biopsy, researchers at MGH surveyed women two to four days following the procedure. They employed a tool called the Testing Morbidities Index (TMI), a survey that evaluates short-term quality of life predicated on seven characteristics, including pain/discomfort and fear/anxiety before and during the procedure, and physical and mental function afterwards. The patients rated each attribute on a scale of one to five, and the final score was adjusted to a scale ranging from 0 for the worst possible experience to 100 for no negative quality-of-life effects. The study enrolled 188 women, ranging from 22 to 80 years old, had an average TMI score of 82 out of 100. Patient age was the only critical separate predictor of the TMI score, which declined by approximately three points for every decade decrease in patient age. The average TMI score for women less than 40 years old was 76.4. "The most important result from this study is that women have short-term decreases in quality of life related to breast biopsy. When we looked at the predictors of quality-of-life score, we found that the strongest predictor is younger age,” said Lee, who has since moved to the University of Washington School of Medicine in Seattle, where she is an associate professor of radiology, as well as the director of breast imaging at Seattle Cancer Care Alliance. Lee mentioned that the results are a bit startling on first view, bearing in mind that younger women as a group are generally healthier than their older counterparts. She cited the major role of anxiety as a chief determinant in explaining the differences. "The prospect of life-threatening disease can produce a lot of anxiety in anyone. Younger women typically have less experience with the health care system in general, and it may be their first time going through a diagnostic testing experience,” said Lee. The study’s findings suggest that tailored pre-biopsy counseling may better prepare women for percutaneous biopsy procedures. "By better explaining what patients can expect during the biopsy experience, we can minimize anxiety before and after the procedure," said Lee. As of today, researchers at MGH, headed by Shannon Swan, M.D., are using the TMI tool to study other screening experiences such as colonoscopy to learn ways to improve the diagnostic testing process for ... Read more

Two recent studies reveal how a “one-stop” concentrated radiotherapy administered during lumpectomy may give some patients with early stage breast cancer a feasible option to existing treatments. Researchers say the method shows promise, however they reason that further research is required to identify which patients will be the benefactors of this new alternative. Most women with breast cancer who receive lumpectomy or partial mastectomy also receive a dose of radiation distributed to the whole of the affected breast. This sort of treatment, known as external beam radiotherapy (EBRT), diminishes the risk of cancer recurring, however it is not a simple treatment and can have serious side effects. It also takes weeks and requires frequent attendance for it to achieve results. This is why some women prefer to have full mastectomy. Met by an insufficient state of affairs, researchers have been exploring whether a single dose of radiation, administered during or soon after surgery and specifically targeted at the site of the tumor, might provide a viable alternative. The two studies, one published in The Lancet and the other in The Lancet Oncology, detail the results of two trials (TARGIT-A and ELIOT), each assessing a different manner of delivering such targeted radiation. In the TARGIT-A trial, a large international team of researchers compared TARGIT with a traditional EBRT course. The TARGIT method employed a small X-ray machine to administer targeted radiation to the tumor site once only during lumpectomy or about a month later, while the EBRT course consisted of daily doses of radiotherapy for between 3 and 6 weeks. Spanning all 12 years of the trial, over 1,700 women experienced TARGIT, and another similar-sized group experienced standard EBRT at over 30 centers. From both groups of women, the difference in the 5-year risk of recurring cancer fell under 2.5%, highlighting that a single TARGIT treatment was no less effective than EBRT in controlling cancer. Additionally, the overall rate of death (number of patients who died within the 5-year period) was 3.9% with TARGIT and 5.3% with EBRT, mostly because of considerably fewer deaths due to other cancers and cardiovascular conditions. When the researchers limited their analysis to only include comparison of TARGIT given during surgery against EBRT, the local recurrence of breast cancer and deaths due to breast cancer were the same in both groups, yet deaths from other causes were considerably lower in the TARGIT group than the EBRT group (1.3% versus 4.4%, respectively). One of the study leaders, Prof. Jayant Vaidya of University College London, UK, said the most significant advantage of TARGIT for women with breast cancer is they can have their complete radiotherapy treatment in conjunction with lumpectomy, with lower toxicity to the breast, the heart and other organs. "Our research supports the use of TARGIT concurrent with lumpectomy, provided patients are selected carefully, and should allow patients and their clinicians to make a more informed choice about individualizing their treatment, saving time, money, breasts and lives,” she said. In The ELIOT trial, published in The Lancet Oncology, a group of researchers in Italy tested a slightly different targeted radiotherapy. Unlike TARGIT where X-rays are used, ELIOT, which is an abbreviation for electron intraoperative radiotherapy, emits electron radiation to the tumor site. The participants were tallied to just over 1,300 women attending the European Institute of Oncology in Milan for early breast cancer treatment, half of whom underwent ELIOT during lumpectomy surgery, and the other half, the controls, underwent traditional EBRT following lumpectomy. The results revealed that cancer recurrence in the affected breast was notably higher in the ELIOT group than in the controls. This was the case regardless of whether the researchers classed recurrence as either to the tumor site or anywhere in the affected breast. However, in spite of all this, the overall survival at 5 years did not greatly differ between the ELIOT and control group; 34 deaths as opposed to 31 deaths respectively. Moreover, there was no considerable difference in deaths caused by breast cancer or by any other causes. For this study, the researchers also analyzed the tumors of women whose cancer returned and discovered tumor size (over 2 cm) and estrogen-receptor negative (ER-negative) were among the factors most likely to be responsible for recurrence. "For women who receive intraoperative radiotherapy, identifying the features most commonly associated with recurrence of cancer in the breast that has been operated on will allow us to identify the patients most likely to benefit from subsequent external radiotherapy,” said study leader Prof. Umberto Veronesi, of the European Institute of Oncology in Milan. “While the rates of local recurrence were much higher in the women who received ELIOT, for some women, the benefits of not having to undergo weeks of radiotherapy outweigh a higher risk of the cancer returning,” he explained. He also notes that it is encouraging to see no real differences between the ELIOT and standard treatment group in terms of deaths; and concludes that such improvements should work to improve the quality of life for patients, in addition to helping physicians make better use of all the available medical information to help identify the patients most likely to benefit from the treatment. In an accompanying comment on both studies, Prof. David Azria and Dr. Claire Lemanski, of the Institut du Cancer Montpellier in France, believe further research is required in order to discover which patients are least likely to suffer breast cancer recurrence following radiation therapy at the time of surgery. "The new data from TARGIT-A and ELIOT reinforce our conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at very low risk of local recurrence,” they ... Read more

Intraoperative radiation therapy (IORT) for early breast cancer showed noninferiority to whole-breast external beam radiation therapy (EBRT) in two randomized clinical trials.Of the larger of the two trials, patients treated with IORT had at least comparable 5-year survival and fewer serious skin complications. IORT was linked to a considerably higher rate of ipsilateral recurrence, albeit the absolute difference fell within the predetermined range for noninferiority. ‘Patients who were randomized to IORT after lumpectomy, instead of before, accounted for the higher rate of ipsilateral recurrence,’ Jayant S. Vaidya, MD, of University College London, and co-authors reported online in the journal, The Lancet. "[IORT] concurrent with lumpectomy within a risk-adapted approach should be considered as an option for eligible patients with breast cancer carefully selected as per the trial protocol, as an alternative to postoperative EBRT," the authors determined. A smaller Italian study produced similar results, as the difference in ipsilateral recurrence matched predetermined specifics for noninferiority for the comparison of IORT and EBRT; however, the difference was statistically in favor of EBRT, as reported online in The Lancet Oncology. Both trials looked to examine the practicability, safety, and effectiveness of treating selected patients with early breast cancer with a single dose of radiation therapy, given directly to the surgically created tumor cavity. Such an approach would decrease the length of radiation therapy and perhaps the skin and other toxicities linked with whole-breast EBRT. The findings reported by Vaidya and peers verified those presented at a conference late last year. Both presentations involved the TARGIT (Targeted Intraoperative Therapy) study, which involved 3,451 women age 45 or older with early-stage invasive ductal carcinoma. Researchers at 33 centers in 11 countries randomized the patients to IORT or EBRT in accordance with breast-conserving surgery. Patients were randomized prior to lumpectomy (pre-pathology, n=2,298) or following (post-pathology, n=1,153). Post-pathology randomization required reopening of the surgical incision for patients grouped to IORT. Of 1,721 patients randomized to IORT, 15.2% needed further EBRT, most whom had pre-pathology IORT. The main endpoint was ipsilateral recurrence, and researchers identified noninferiority as a difference in recurrence rate with IORT vs. whole-breast EBRT of no more than 2.5%. Vaidya and peers reported findings from an average follow-up of 2.5 years, including 1,222 patients followed for 5 years. The results revealed ipsilateral recurrence rates of 3.3% with IORT and 1.3% with EBRT (P=0.042). While analysis by the timing of randomization showed that patients randomized prior to lumpectomy had recurrence rates of 2.1% with IORT and 1.1% with EBRT, still within the limits of noninferiority (P=0.31). However, in comparison patients randomized following lumpectomy had recurrence rates of 5.4% with IORT and 1.7% with EBRT, a difference that surpassed the agreed definition of noninferiority, although it did not garner much statistical significance (P=0.069). Breast cancer mortality was 2.6% with IORT and 1.9% with EBRT, an insignificant difference. However, non-breast cancer mortality was considerably lower in patients in the IORT group (1.4% vs. 3.5% with EBRT, P=0.0086). Overall mortality was 3.9% in the IORT group and 5.3% with EBRT (P=0.099). Injury-related complications took place in a comparable percentage of patients in the two treatment groups. Grade 3-4 skin complications occurred considerably less often with IORT (four cases opposed to 13 with EBRT, P=0.029). The Italian study involved 1,305 patients 48 to 75 with early breast cancer eligible for breast-conserving surgery. They were randomized to IORT or EBRT, and the main endpoint was ipsilateral recurrence. The trial was statistically powered for equivalence, which was outlined by a difference of no more than 7.5% for IORT vs. EBRT.After an average follow-up of 5.8 years, patients in the IORT group had a 5-year event rate of 4.4% (35 recurrences in 651 patients) as opposed to 0.4% in the EBRT group (four of 654 patients, ... Read more

Regular screening can raise women’s chances of breast cancer survival by detecting the disease early and being able to treat it at such a pivotal stage. A team of Dutch researchers developed a prototype of a new imaging tool that may soon be able to identify breast cancer in its early stages, when the disease is most treatable. The new device, known as photoacoustic mammoscope, if proven effective would become a totally different approach to breast imaging and detecting cancer. Instead of X-rays, which are utilized in traditional mammography, the photoacoustic breast mammoscope uses a mixture of ultrasound and infrared light to create a three-dimensional (3D) map of the breast.  The researchers, from the University of Twente (Enschede, The Netherlands), published facts and information of their newly developed imaging tool in an article published in the October issue of The Optical Society’s (OSA) open-access journal Biomedical Optics Express. As for the new imaging system itself, infrared light is distributed in billionth-of-a-second pulses to tissue, where it is dispersed and absorbed. The high absorption of blood elevates the temperature of blood vessels only slightly, which in turn causes them to experience a minor, but hasty expansion. While imperceptible to the patient, this expansion produces distinguishable ultrasound waves that are then used to form a 3D map of the breast vasculature. And because cancer tumors have more blood vessels than any of the surrounding tissue, they are quite distinct in this image. As of today the resolution of the images is not as detailed or refined as what can be captured with current breast imaging techniques such as X-ray mammography and magnetic resonance imaging (MRI). In future versions, assistant professor at the University of Twente, Dr. Srirang Manohar , who led the research, graduate student at the University of Twente, Wenfeng Xia , who served as the first author on the new study, and their peers expect to enhance and advance the resolution as well as add the ability to image using several different wavelengths of light at once, which is projected to improve detectability. The Twente researchers have assessed their prototype in the laboratory using phantoms (objects made of gels and other elements that imitate human tissue). In 2012, in a small clinical trial they revealed that an earlier version of the imaging tool could in fact successfully image breast cancer in women. Manohar and his team added that if the instrument were placed on the market, it would probably cost even less than MRI and X-ray mammography tests. “We feel that the cost could be brought down to be not much more expensive than an ultrasound machine when it goes to industry,” said Xia. The next stage of the research, the researchers note, will be to plan for large, more extensive clinical trials. Several existing technologies are already widely used for breast cancer screening and diagnosis, including mammography, MRI, and ultrasound. Before becoming frequently used, the photoacoustic mammoscope would have to be at least as effective and efficient as those other imaging modalities in large, multicenter clinical trials. “We are developing a clinical prototype that improves various aspects of the current version of the device. The final prototype will be ready for first clinical testing next year," said ... Read more

Researchers from the University of Chicago are developing both computer-aided diagnosis (CADx) and quantitative image analysis (QIA) methods that can be applied to mammograms, ultrasounds, and magnetic resonance images (MRIs) in order to effectively ... Read more

Based on recent research, optical imaging technology, which measures metabolic activity in cancer cells, can precisely distinguish breast cancer subtypes and can detect responses to treatment as early as two days following therapy. The study’s findings were published in the October issue of Cancer Research, a journal of the American Association for Cancer Research.   “The process of targeted drug development requires assays that measure drug target engagement and predict the response [or lack thereof] to treatment,” said graduate student in the department of biomedical engineering at Vanderbilt University (Nashville, TN, USA), Alex Walsh. “We have shown that optical metabolic imaging [OMI] enables fast, sensitive, and accurate measurement of drug action. Importantly, OMI measurements can be made repeatedly over time in a live animal, which significantly reduces the cost of these preclinical studies.” Human cells are subjected to wide chemical reactions known as metabolic activity to generate energy and this activity is modified in cancer cells. Cancer cells’ metabolic activity fluctuates when treated with anticancer drugs. OMI makes use of the fact that two molecules involved in cellular metabolism, called nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD), naturally give off fluorescence when exposed to particular forms of light. In this way, OMI produces characteristic signatures for cancer cells with a different metabolism and their responses to medications. Walsh and colleagues used a custom-built, multiphoton microscope and attached it with a titanium-sapphire laser that causes NADH and FAD to emanate fluorescence. They applied specific filters to segregate the fluorescence emitted by these two molecules, and measured the ratio of the two as “redox ratio.” When they placed normal and cancerous breast cells under the microscope, OMI produced noticable signals for the two types of cells. OMI could also distinguish between estrogen receptor-positive, estrogen receptor-negative, HER2-positive, and HER2-negative breast cancer cells. The researchers then studied the effect of the anti-HER2 antibody trastuzumab on three breast cancer-cell lines that react differently to the antibody. They discovered that the redox ratios were considerably reduced in drug-sensitive cells after trastuzumab treatment, but unaffected in the resistant cells.  They then grew human breast tumors in mice and treated some of these using trastuzumab. When they imaged the tumors in live mice, OMI showed a difference in response between trastuzumab-sensitive and -resistant tumors as early as two days following the first dose of the antibody.  Fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging, in comparison, imaging, the standard clinical metabolic imaging modality, could not measure any conceivable difference in response between trastuzumab-sensitive and -resistant tumors at any time point throughout the research, which went on for a duration of 12 days. According to the researchers, OMI can be utilized on newly removed tissues from patients; however, with additional refinements, it could be incorporated in endoscopes for live imaging of human cancers. “Cancer drugs have profound effects on cellular energy production, and this can be harnessed by OMI to identify responding cells from nonresponding cells. We are hoping to develop a high-throughput screening method to predict the optimal drug treatment for a particular patient,” concluded ... Read more

Based on a study published in JAMA Internal Medicine, patients who are in the early stages of breast cancer and receive radiation treatments on the left side of their body in a facing-up position were shown to be at a greater risk of contracting heart disease. Researchers from the Columbia University Medical Center in New York say that prior research has suggested a connection between breast cancer radiation and long-term cardiovascular-related deaths. In fact, earlier this year a study that was published in the New England Journal of Medicine, suggested that breast cancer patients who receive radiation therapy are at a slightly higher risk of contracting heart disease within 5 years of treatment. According to this most recent study, researchers analyzed 48 patients with stage 0 breast cancer, which is the earliest form of the disease, up to stage IIA breast cancer. This is a stage of breast cancer in which no tumors are detected; however, cancer is noticeable in 1 to 3 axillary lymph nodes. All patients were treated after 2005 at the New York University Department of Radiation Oncology, and the patients' cardiac risks were measured over a 20-year period after radiotherapy. According to the researchers, this is the estimated average life expectancy after early stage breast cancer. The researchers determined the connection between radiotherapy and heart disease by taking the following the determinants into account: ? Mean cardiac radiation dose ? Cardiac risk of each patient (smoking, cholesterol and hypertension) ? Side of the body that received radiation ? Body position ? Coronary events induced by radiation therapy The study’s discoveries showed that women who had the highest baseline cardiac risk, who underwent radiation therapy on the left side of their body while in a face-up position, demonstrated the greatest risk for contracting heart disease. Women who had low cardiac risk at the baseline of the study, who underwent radiation therapy on the right side of their body exhibited the lowest risk of heart disease. The researchers discovered that patients who were administered radiation therapy on the left side of their body while in the prone position, lying down and facing down , had reduced radiation dosage and reduced cardiac risk. Body positioning had little to no effect on cardiac risk on right-sided therapy, the researchers note, as the heart is always out of the area of radiation. Ultimately the researchers conclude that breast cancer patients receiving radiation therapy could significantly cut the risk of developing heart disease by reducing other cardiovascular risk factors. "Because the effects of radiation exposure on cardiac disease risk seem to be multiplicative, the highest absolute radiation exposure risks correspond to the highest baseline cardiac risk. Consequently, radiotherapy-induced risks of major coronary events are likely to be reduced in these patients by targeting baseline cardiac risk factors (cholesterol, smoking, hypertension), by lifestyle modification, and/or by pharmacological treatment,” they ... Read more