3-D breast biopsies offer new hope in fight against cancer

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Women tested for breast cancer at Magee-Womens Hospital of UPMC now have a faster screening option that eventually could supplant older screening techniques across the country.

Last month, Magee became the first hospital in the country to perform a 3-D guided breast biopsy, a procedure that more quickly and accurately locates possible cancers and exposes patients to less radiation than older methods, said Jules Sumkin, chief of radiology at Magee.

The idea to develop the technology came when Magee researchers worked with Hologic Inc., a company that manufactures mammography and breast biopsy equipment, to develop tomosynthesis, a 3-D mammography technique, in 2005.

Radiologists found that tomosynthesis allowed them to find abormalities in the breast that are difficult to see using conventional mammography. Tomosynthesis has allowed radiologists to identify about 30 percent more breast cancers than conventional mammography, Dr. Sumkin estimates.

But it was difficult to reproduce the advanced images taken by tomosynthesis mammography with the imaging tools in existing biopsy technology.

Magee researchers and Hologic addressed that issue by developing a 3-D guided breast biopsy technique. The technology improves biopsy technology in much the same way that tomosynthesis advanced mammography: Three-dimensional imaging creates a complete reconstruction of the breast to more accurately identify possible lesions and calculate their depth.

In traditional-guided biopsies -- known as stereotactic biopsies -- images are taken at two angles of the breast to calculate the depth of the possible lesion. The three-dimensional technique is able to measure lesion depth more accurately.

Not all women require biopsies using mammography as a guide. But those who do, including women with especially hard-to-detect cancers, will especially benefit from 3-D guided biopsy, Dr. Sumkin said.

"If we can do a biopsy with ultrasound guidance, that's preferable," he said, "but there is a subset of patients where you can't find it by ultrasound" because of body variations."

During a 3-D biopsy a patient sits upright rather than lying on a table. This benefits women who have difficulty lying down due to arthritis or other health complications, Dr. Sumkin said.

Among other benefits to patients using this technology, procedure time is shorter and exposure to radiation is reduced. Because the stereotactic method requires that at least two images be taken, more X-ray doses are needed.

Unlike stereotactic biopsies, which require expensive, standalone machines, 3-D biopsies are performed using a piece of equipment attached directly to tomosynthesis machines, which is "a huge cost saving," Dr. Sumkin said.

Still, tomosynthesis is far less prevalent than two-dimensional mammography. Dr. Sumkin cited cost as the main barrier to hospitals' adoption of the technology. "For a hospital to buy this equipment and not be reimbursed for it does not work in this day and age," he said. Dr. Sumkin estimates that there are just six or seven tomosynthesis machines in Pittsburgh.

Magee so far has performed 50 to 60 3-D guided breast biopsies Dr. Sumkin estimates.

Even though it's a new procedure, some insurance plans have been covering its cost, but some, including Medicare, do not cover tomosynthetic mammograms, he said.

Dr. Sumkin is optimistic that the benefits of tomosynthesis can save money in the long term.

Tomosynthesis allows doctors to detect and treat deadly cancers early, which is much less costly than treatment at later stages.

Christine Hafera, 50, from Natrona Heights, who received a 3-D guided biopsy last month, said that the procedure "went extremely well and it took just 40 minutes." Ms. Hafera's procedure was covered by health insurance.

"Over lying on a table, I'm all for it," she said.

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Marina Bolotnikova: mbolotnikova@post-gazette.com or @mbolotnikova.


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