Jon E. Ekstrom, MD · Breast Carcinoma 1 in 8 U.S. Women will develop Breast CA In 2015 estimated...
Transcript of Jon E. Ekstrom, MD · Breast Carcinoma 1 in 8 U.S. Women will develop Breast CA In 2015 estimated...
Jon E. Ekstrom, MD
I have no relevant financial disclosures
Breast Carcinoma 1 in 8 U.S. Women will develop Breast CA In 2015 estimated 231,840 new cases of invasive breast
CA and 60,290 new cases of in situ disease. In 2015, 40,290 Breast CA deaths are expected with
mortality rate decreasing since 1989. In 2015, there are more than 2.8 million women in the
U.S. with current or past history of Breast CA.
Breast CA in Oregon Oregon is ranked the 2nd highest in the nation for
Breast CA incidence (128.6/100,000) WA is # 1. Leading cancer Dx in Women from all racial and
ethnic groups. The % of early stage (localized and in situ) is 74% The mortality rate of Breast CA in OR is lower than the
national average. ? Northwest has high rate of Breast CA screening and
large population of older white women who may have better outcomes than many minorities
Screening Mammography Recent conflict and debate Population based policy vs individualized medicine. In most practices, 10 – 15% of new Breast CA diagnosis
are in women less than age 50. We cannot reliably inform a patient when it is safe to
postpone screening. 1/6 Breast CA deaths attributed to diagnosis in 40’s 1/3 of all years of life lost to Breast CA are from
diagnosis before age 50.
Breast Density and Cancer Risk Increased Breast density is a marker of increased risk
for developing Breast CA. No Increase in Breast CA Mortality. BIRADS Lexicon. No Standardization (subjective) Decreased Detection of Breast Ca. ? Surrogate Marker of cellular proliferation. ?Reflection of endogenous hormone environment. Is past or current breast density most important to
establish risk?
Breast Density
Mammography History Standard X-Ray Mammography (-1930) Xerox Mammography (1970 – 1985) Film / Screen Based Mammography (1980s – 2010) Digital Mammography (2005 – Current) 3D Mammography (Tomography)
Conventional Mammography
Tissue superimposition
Projection imaging
Detector
Breast
Compression Plate
X-rays
Problems Often unclear detection method High amounts of over-diagnosis and under-diagnosis This leads to multiple unnecessary screenings and
more exposure to X-ray radiation Limited 2-dimensional image leaves about 10% of
cancers undetected Denser breast tissue is difficult to read in some
patients
3D Mammography=Tomosynthesis First system approved by FDA – 2011 System acquires multiple images of the Breast through
a moving Beam. Images are reconstructed at 1 mm slices.
2D image is generated from the tomosynthesis data
Tomosynthesis
Utilizes low-level X-rays to produce multiple images of the breast, layer by layer, using a swinging camera
This layering of images makes it simpler to detect normal breast structures (milk ducts, lobules, fatty tissues, etc.) from cancerous ones
X-rays are converted into limited 3-dimensional digital images for radiologists to examine
Computer Aided Detection (CAD) assists in spotting regions where cancer seems to be present
Dense tissue is more easily examined through Tomography than traditional Mammography
Tomosynthesis
Digital Breast Tomosynthesis
Tomographic Imaging
Tube Rotation
Detector
Breast
X-rays
Compression Plate
• Tissue superimposition :• hides pathologies in 2D• mimics pathologies in
2D
Why 3D Mammography/DBT?
16
Why 3D Mammography?
Tomosynthesis: A Better Mammogram ADVANTAGES
Higher Detail Helps Delineate
Overlapping Tissues Increased CA Detection
Rate Decreased Call Back
Rate
DISADVANTAGES Longer Interpretation
Time More Costly (>80 % of
Carriers are Covering) Still Difficulties with
Uniformly very dense Breast Tissue
Tomosynthesis (cont.) Increases detection of Invasive breast cancers by 40%
in comparison to 2D mammography Total cancer detection increased from 6.1 patients per
thousand to 8.0 patients per thousand (a 27% increase)
False-positive readings reduced by 15% Uncertain readings and patient call-backs reduced by
20-30%
Clinical Performance: Overall CA detection Rate increased 27% over Digital
Mammography (Oslo trial – 12,631 screenings in 2 yrs) False Positive Rate Decreased by 15%
Tomosynthesis
2D MammographyA suspicious region
3D Mammography (slice 17)A highly suspicious region
Hologic – Proprietary and Confidential
EXAMPLE
sametissue
Hologic – Proprietary and Confidential
EXAMPLE
sametissue
2D MammographyA worrisome region
3D Mammography (slice 22)A very worrisome region
Reduced Call Backs
Reduced Call Backs
Tomosynthesis 2D images from Tomosynthesis Data (C View) Hologic (2011). Reduce Exposure Time and Dose. Dose is equivalent
to Conventional Digital Mammography.
Tomosynthesis
Example8/10/2015 Digital Mammo 8/20/2015 Tomo Mammo
Ultrasound Findings3:00 Lesion 1:00 Lesion
Tomosynthesis: Additional Advantages More accurate Characterization of Lesion Size
Able to Locate Difficult Lesions in 3 Dimensions
Image Guided Biopsy Systems
Contrast Enhanced Mammography
Guided Biopsy Localize Target in x,y,
and z Planes. More Comfortable than
Prone Stereotactic Table
Contrast Enhanced Tomo
Contrast Enhanced Tomo Patients who are not MRI Candidates
Where MRI is not Available
Reduced Cost over MRI
Still a Work in Progress
Thank You