Detection and Treatment Using MRI and Lasers
(LITTLE ROCK, AR) - Early detection of breast cancer can be followed with a non-scarring breast lumpectomy says Arkansas researcher Steve Harms, M.D., Director of Imaging Research at the University of Arkansas for Medical Sciences (UAMS). This week Harms reported the outcome of 15 patients who in the last year received an outpatient, laser procedure-rather than the incision-type surgery--to remove early and sometimes middle stages of cancerous breast tumors.
"It's early and more studies are necessary, but it is a very promising alternative for women who want to avoid disfiguring surgery," Harms said at the annual Radiological Society of North America. "Because we don't make an incision, there is no scar and virtually no evidence of surgery."
As the lead researcher, Harms described the procedure: a physician places a needle in the tumor and then advances a fiber optic wire through the needle. The wire is used to apply laser heat, which destroys the tumor after about 10 minutes.
Recognized worldwide since 1990 for developing MRI (Magnetic Resonance Imaging) breast screening applications, Harms and his research group produced the first high-resolution breast MRI images by developing a software called ROtating Delivery of Excitation Off-resonance (RODEO).
By enhancing the MRI to be 100 times more effective with this new software, better outcomes for treating breast cancer evolved. Under his direction, more than 1500 clinical examinations were conducted. All RODEO testing results-initially those at UAMS and two other leading clinical sites at the University of Pennsylvania and the University of California at San Francisco-are collected in a database that records information from breast MRI examinations performed throughout the world.
Starting in the early 1990s, they have been honored for their work by nationally known foundations, said Harms. "We have been given awards from the Komen Foundation, the American Medical Association, and the Radiological Society of North America with the Shannon Award. When we introduced RODEO Breast MRI, it caught the radiology world by surprise. We also were recognized globally in major newspapers and featured in most of the women's magazines."
Because this software offers tremendous breakthroughs in breast imaging, last year, the Department of Health and Human Services funded multi-site clinical trials. From that work, new recommendations for current standards in the breast cancer screening and treatment were established by an international consortium, composed of five working groups with Harms serving as chief investigator. The Office on Women's Health will soon publish their conclusions.
Harms explained, "Although Rodeo has about a 100 times the resolution of a standard MRI, more importantly, it can better demonstrate cancer than mammography. MRI--using this RODEO technique in the same patients--detected twice as much cancer and had three times the specificity. Mammography often was demonstrated in recent studies to show a false positive, which means, when a woman finds out she may have a cancer on a mammogram, only about 20 percent of the time does it turn out to be a cancer when the final pathology is done."
LUMPECTOMY
Rodeo MRI is proving to be especially helpful in the breast surgery called a lumpectomy, where only part of the breast is removed. With RODEO software, the surgeons can identify on the MRI where all of the tumor is located, and avoid repeat surgeries.
Harms said, "The ideal treatment for breast cancer, in terms of surgery, would be a lumpectomy. This preserves much of the breast tissue and reduces the deformity associated with breast cancer. Unfortunately, about half of the lumpectomies that are performed, have positive margins; in other words, the surgeon cuts across a part of the tumor and leaves some tumor behind in about half of the cases. This requires repeat surgery, either another lumpectomy or a mastectomy, and the other side of that, sometimes when you have no positives margins, more breast tissue is removed than actually is needed to cure the cancer. In that case, the deformity is worse than is needed.
"So, what we want to do is provide the information needed to do the ideal lumpectomy, in other words, one that removes all the cancer and preserves as much of the normal breast tissue as possible. RODEO allows us to very accurately to identify the margins of that cancer."
INCONCLUSIVE MAMMOGRAMS AND FALSE POSITIVES
Patients, who have a false positive from a standard breast exam, are finding that the MRI, using the RODEO technique, is a helpful alternative to the inconclusive mammogram, explained Harms. "The RODEO technique is an alternative to the inconclusive mammogram. In other words, patients who may not be well examined with mammography would include women with increased breast density, which occurs more commonly in pre-menopausal patients.
"Most women and their physicians are aware of the controversial regarding mammography and whether to get it at age 40 or whether to go on to age 50. This controversial comes from the fact that mammography doesn't work as well in pre-menopausal women because of the active ductal tissue. As hormonal supplements after menopause become more common, we are also seeing more breast density in the post-menopausal patients. So RODEO breast MRI may also be indicated in women on the age of 50 with active or prominent ductual tissue."
SILICONE IMPLANTS
Harms also noted how the breast MRI, using the RODEO software technique helps women with silicone implants. As a group, these patients also can have inconclusive mammograms. RODEO can distinguish between any leaks from the implants and possible tumors,
Harms said, "People with silicone implants also have inconclusive mammograms. Silicone blocks X-rays and impairs mammography for making a diagnostic picture in many cases. Rodeo breast MRI can not only see through the silicone, but it also chemically can separate silicone from lesions in the breast. We often use Rodeo breast MRI to evaluate the integrity of the implant and to characterize lumps in the breast as either silicone leaks or possibly tumors because silicone has a characteristic signal that we can exploit RODEO MRI to make a chemically specific image for silicone. We can separate this from enhancing tumors in the breast quite readily. So, indeed we can tell a leak from a lump."
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Media contact: Bonnie Brandsgaard 501-686-8013, [email protected]
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