A breast MRI (magnetic resonance imaging) exam is a non-invasive diagnostic examination that uses magnetic fields to capture multiple images of the breast tissue to create detailed, computer-generated pictures of your breasts.
A breast MRI sometimes is used to diagnose and evaluate breast tumors. Under some circumstances, this test may better identify a small mass within a woman’s breast than a mammogram or ultrasound, particularly for women with very dense (non-fatty) breast tissue and can be very beneficial to detect early cancer in high risk patients.
Breast MRI’s are also used as an assessment tool to evaluate the extent of breast cancer.
Breast MRI is also very useful in the evaluation of breast implants.
Dr. Kathleen Greatrex is here to discuss all the latest breast cancer technologies.
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An Update On The Latest Breast Cancer Technologies
Featured Speaker:
Learn more about Dr. Kathleen Greatrex
Kathleen Greatrex, MD
Kathleen V. Greatrex, M.D. is one of the nation’s leading experts on breast imaging and dedicates a great deal of time educating women about breast cancer. Dr. Greatrex graduated from Temple University School of Medicine. She was elected to membership in the Epsilon Chapter of the Alpha Omega Alpha Medical Honor Society. She completed her Residency at Temple University Hospital and her Fellowship training in Breast and Body Imaging at Memorial Sloan-Kettering Cancer Center in New York. Dr. Greatrex is President of Lourdes Imaging Associates, and serves as Chair of the Department of Radiology and Nuclear Medicine, as well as Division Chief of Breast Imaging for the Lourdes Health System. She holds the distinction of being the first female President of the Medical Staff in the 60 year history of the medical center. She has served as a board member of the Lourdes Health Foundation and in 2013 she was appointed to the Board of Trustees for the Lourdes Health System and just recently Dr. Greatrex was appointed to the Board of Trustees for Immaculata University. Dr. Greatrex has been named the first female President of the Medical Staff at Lourdes Medical Center of Burlington County with her term beginning in 2015.Learn more about Dr. Kathleen Greatrex
Transcription:
An Update On The Latest Breast Cancer Technologies
Melanie Cole (Host): Lourdes Health System offers a comprehensive breast care imaging program with all the imaging modalities necessary to treat breast cancer at its earliest most treatable stages. My guest today is Dr. Kathleen Greatrex. She’s the Chair of the Department of Radiology and Nuclear Medicine and the Division Chief of Breast Imaging for the Lourdes Health System. She’s also one of the nation’s leading experts on breast imaging. Welcome to the show, Dr. Greatrex. Tell us what type of imaging modalities are available to catch and treat breast cancer early.
Dr. Kathleen Greatrex (Guest): Well, besides the mainstay of diagnosis--digital breast mammography, there are other ways to diagnose it: ultra sound imaging, MRI imaging and now the new 3D tomosynthesis imaging that’s being utilized in many centers across the country, not all. We are very fortunate that we just got our 3D breast tomosynthesis machine, so we are up and running and using it on a daily basis, especially in those women with dense breasts. It’s really proven to be quite important in imaging the breast in a way that 2D imaging can’t. It’s been proven to increase the sensitivity of picking up breast cancers by about 27% and really very, very helpful in those women who are younger, and have dense breast tissue where reading a 2D image is quite difficult. So, it’s really helped us a lot in diagnosing this disease when we can get it at a stage that it can be treated.
Melanie: So, tell us a little bit more about the tomosynthesis. Is this, do you think, going to be more of a main stream or is it something you use for diagnostic? Every woman dreads that waiting period from their mammogram to the “we need to see you again”. Is this the second thing you do or would this replace the standard 2D mammogram?
Dr. Greatrex: It’s not going to probably replace the 2D mammogram but it’s going to be used in conjunction with the 2D mammogram and that’s how we are offering it. We are giving women the option of getting the study. We also recommend it in women who have dense breast tissue. We look at their prior studies; we can deduce how dense the breast tissue is and, at that that point, we can recommend a breast tomosynthesis. The FDA approved it in February 2011 and it’s a method of imaging the breast in three dimension. The images slices are about a millimeter thick and we can actually image the breast in several different angles. We use these multiple images to reconstruct the 3D dataset. The process is really similar to a CT scan. You actually view the body at different angles and then you reconstruct the volume. There have been multiple studies which have shown that the sensitivity for picking up breast cancers increased from 66% to 76%. The true positive rate, or specificity increases, from 81% to 89% and the beautiful thing about this is that the recall rate – that’s the rate at which we have women come back for other images--was reduced by 43%. So, this is a great modality for putting a woman’s mind at rest when she gets her mammogram.
Melanie: That’s great information and so nice for women to hear. Now, what about if you spot something? People hear about breast ultrasounds and they wonder why that’s not the first thing that you do. Tell us about some of the other things that you do if you spot something suspicious.
Dr. Greatrex: If we spot suspicious, we want to find out: is it a solid something or is it a cyst? If it’s a cyst and it fills the criteria of a cyst, then we can be almost 100% assured that it’s a benign process. However, if it is solid on ultrasound, then we’ve got to look at it a little bit further. It’s at that point that we more than likely, in most cases, will recommend a biopsy. Other ways that you can evaluate women after we spot compress something and we see something that’s not quite right, is an MRI. An MRI is a great modality for evaluating soft tissue masses to deduce whether it is a benign process, like a fibroadenoma or is it a malignant process? MRI is another modality besides ultrasound. We’ve got a lot of things in our arsenal that help us to evaluate areas that are asymmetrical in the breast; that are questionable--either the woman feels it or we see it on the mammogram. Ultrasound has proven to be quite a simple procedure. No radiation is associated with an ultrasound but it gives us the way in which to deduce whether something is a cyst or a solid mass. There is also ultrasound-guided core biopsy under ultrasound guidance, which is also very simple to do as opposed to other means of which we do biopsies.
Melanie: What do you recommend for women who have dense breasts, because now there’s even breast density laws being put around that you let a woman know that this is what she has. Do women with dense breasts and, as we get older, do we ask you for an ultrasound or a breast MRI just to be sure every year?
Dr. Greatrex: What happens is, when we read the mammogram, now we are mandated in the state of New Jersey, state of Pennsylvania, we’re mandated--and there are other states across the country as well--that we have to report that on the mammogram itself--in the report--whether the tissue is dense or whether it’s fatty. If it is dense, how dense is it? We categorize it from a 1 to a 4. One and two usually means that the breast tissue is more fatty than dense. In those cases, we don’t really recommend that any further imaging be performed. However, in those women with category 3 and 4 dense breast tissues, it’s those women that we are a little bit unsure about because when you read a mammogram and it’s very dense, it’s like looking through a snow storm. It’s just a white blanked out tissue. So, I mean, it’s very, very difficult to read a mammogram when you’re trying to look through this very dense breast tissue. In those women, we do recommend that either they get a follow up ultrasound as a second way for us to look at the breast tissue or a tomosynthesis. The interesting thing that research has found is that breast tissue density is a significant independent risk factor for breast cancer. It increases the relative risk by 4-5 times, which is a pretty big number. Also, the false positive rates increase and the sensitivity and specificity of mammography is reduced. So, when we see dense breast tissue, it’s really important for the patient to be alerted and they are usually alerted through their physician that ordered the study to begin with--their mammogram--and have them return for bi-lateral breast ultrasound or bilateral tomosynthesis as another means as which for us to look at the breast tissue. It’s interesting that in our younger patients, you’re going to see much denser breast tissue because the breast tissue, at that point, is very hormonally responsive. There are all these hormones of estrogen and progesterone that are flowing through the body and they have an effect on breast tissue by causing this increased density. As we get older, the levels of estrogen and progesterone diminish and there, too, the degree of density of breast tissue diminishes. The reading of mammogram in the later years of life is a little easier than it is in the younger years of life but you never want to miss a breast cancer in a young person and that’s why we always recommend that women follow up with these other modalities so that we can look through and look at the breast tissue in a different way.
Melanie: Dr. Greatrex, what do you tell women when they ask you and they see in the media that certain organizations are even dis-recommending mammograms now or recommending them a little bit less frequently. What do you tell them when they ask you about this?
Dr. Greatrex: I find it to be very distressing because I diagnose women in their forties with breast cancer and to know that there’s a potential of missing it and not seeing it, or, not even that, but they never had a mammogram as a screening study beginning at age 40 and every year after that. Say, if they got breast cancer at the age of 40 or 42, or whatever, and we never did a mammogram. We would never know. What they’ve found is that when you consider the statistics in this country for breast cancer, one in eight women are going to get breast cancer in this country. You’re talking about not screening women on a yearly basis after the age of 40? We are going to miss breast cancers. Women are needlessly going to die. The lymph node involvement or the spread of the tumors will increase. The numbers of women that are going to need mastectomies will increase. The numbers of women that are going to need chemotherapy are going to increase. So, I am not an advocate of the changes that have been talked about. I believe that we should continue to do the screening as we have in the past every year after the age of 40. I think it should stand as that.
Melanie: Beautifully put and so well spoken, Dr. Greatrex. In just the last few minutes, give us your best advice for women and all of this terminology that we’ve gone through today about breast imaging and the breast imaging studies and the diagnostic tools that you use and why they should come to Lourdes Health System for their care.
Dr. Greatrex: I think it’s because we pride ourselves on treating the entire person. I always think about each patient and it’s not just the patient. It’s everyone in that patient’s lives that love them are impacted by what we do. We always take those things into consideration. I lost my mother to breast cancer when I was a medical student. She was 56. So, I come with a history that makes me very cognizant of the patients I take care of and the families that are affected by what the decisions I make for each patient. So, I think given that we have a very strong empathy here. I think also the fact that we’ve got amazing equipment--the best that you could have, we have here: 3D mammography, breast MRI, stereotactic biopsy, ultrasound-guided core biopsy capability. We can do everything and we have the trained professionals to do it. I‘m one of the few fellowship-trained breast imagers probably in this area. I trained at Memorial Sloan Kettering Cancer Center and I think it’s probably one of the finest centers in the world to learn about breast cancer, breast imaging. I pride myself on my knowledge, what I’ve learned and what I’ve brought here to Lourdes. I was born at Lourdes so I have a strong feeling about the place and certainly the type of care that we give I think is second to none.
Melanie: Thank you doctor so much. It’s great information. You’re listening to Lourdes Health Talk. For more information you can go to LourdesNet.org. That’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.
An Update On The Latest Breast Cancer Technologies
Melanie Cole (Host): Lourdes Health System offers a comprehensive breast care imaging program with all the imaging modalities necessary to treat breast cancer at its earliest most treatable stages. My guest today is Dr. Kathleen Greatrex. She’s the Chair of the Department of Radiology and Nuclear Medicine and the Division Chief of Breast Imaging for the Lourdes Health System. She’s also one of the nation’s leading experts on breast imaging. Welcome to the show, Dr. Greatrex. Tell us what type of imaging modalities are available to catch and treat breast cancer early.
Dr. Kathleen Greatrex (Guest): Well, besides the mainstay of diagnosis--digital breast mammography, there are other ways to diagnose it: ultra sound imaging, MRI imaging and now the new 3D tomosynthesis imaging that’s being utilized in many centers across the country, not all. We are very fortunate that we just got our 3D breast tomosynthesis machine, so we are up and running and using it on a daily basis, especially in those women with dense breasts. It’s really proven to be quite important in imaging the breast in a way that 2D imaging can’t. It’s been proven to increase the sensitivity of picking up breast cancers by about 27% and really very, very helpful in those women who are younger, and have dense breast tissue where reading a 2D image is quite difficult. So, it’s really helped us a lot in diagnosing this disease when we can get it at a stage that it can be treated.
Melanie: So, tell us a little bit more about the tomosynthesis. Is this, do you think, going to be more of a main stream or is it something you use for diagnostic? Every woman dreads that waiting period from their mammogram to the “we need to see you again”. Is this the second thing you do or would this replace the standard 2D mammogram?
Dr. Greatrex: It’s not going to probably replace the 2D mammogram but it’s going to be used in conjunction with the 2D mammogram and that’s how we are offering it. We are giving women the option of getting the study. We also recommend it in women who have dense breast tissue. We look at their prior studies; we can deduce how dense the breast tissue is and, at that that point, we can recommend a breast tomosynthesis. The FDA approved it in February 2011 and it’s a method of imaging the breast in three dimension. The images slices are about a millimeter thick and we can actually image the breast in several different angles. We use these multiple images to reconstruct the 3D dataset. The process is really similar to a CT scan. You actually view the body at different angles and then you reconstruct the volume. There have been multiple studies which have shown that the sensitivity for picking up breast cancers increased from 66% to 76%. The true positive rate, or specificity increases, from 81% to 89% and the beautiful thing about this is that the recall rate – that’s the rate at which we have women come back for other images--was reduced by 43%. So, this is a great modality for putting a woman’s mind at rest when she gets her mammogram.
Melanie: That’s great information and so nice for women to hear. Now, what about if you spot something? People hear about breast ultrasounds and they wonder why that’s not the first thing that you do. Tell us about some of the other things that you do if you spot something suspicious.
Dr. Greatrex: If we spot suspicious, we want to find out: is it a solid something or is it a cyst? If it’s a cyst and it fills the criteria of a cyst, then we can be almost 100% assured that it’s a benign process. However, if it is solid on ultrasound, then we’ve got to look at it a little bit further. It’s at that point that we more than likely, in most cases, will recommend a biopsy. Other ways that you can evaluate women after we spot compress something and we see something that’s not quite right, is an MRI. An MRI is a great modality for evaluating soft tissue masses to deduce whether it is a benign process, like a fibroadenoma or is it a malignant process? MRI is another modality besides ultrasound. We’ve got a lot of things in our arsenal that help us to evaluate areas that are asymmetrical in the breast; that are questionable--either the woman feels it or we see it on the mammogram. Ultrasound has proven to be quite a simple procedure. No radiation is associated with an ultrasound but it gives us the way in which to deduce whether something is a cyst or a solid mass. There is also ultrasound-guided core biopsy under ultrasound guidance, which is also very simple to do as opposed to other means of which we do biopsies.
Melanie: What do you recommend for women who have dense breasts, because now there’s even breast density laws being put around that you let a woman know that this is what she has. Do women with dense breasts and, as we get older, do we ask you for an ultrasound or a breast MRI just to be sure every year?
Dr. Greatrex: What happens is, when we read the mammogram, now we are mandated in the state of New Jersey, state of Pennsylvania, we’re mandated--and there are other states across the country as well--that we have to report that on the mammogram itself--in the report--whether the tissue is dense or whether it’s fatty. If it is dense, how dense is it? We categorize it from a 1 to a 4. One and two usually means that the breast tissue is more fatty than dense. In those cases, we don’t really recommend that any further imaging be performed. However, in those women with category 3 and 4 dense breast tissues, it’s those women that we are a little bit unsure about because when you read a mammogram and it’s very dense, it’s like looking through a snow storm. It’s just a white blanked out tissue. So, I mean, it’s very, very difficult to read a mammogram when you’re trying to look through this very dense breast tissue. In those women, we do recommend that either they get a follow up ultrasound as a second way for us to look at the breast tissue or a tomosynthesis. The interesting thing that research has found is that breast tissue density is a significant independent risk factor for breast cancer. It increases the relative risk by 4-5 times, which is a pretty big number. Also, the false positive rates increase and the sensitivity and specificity of mammography is reduced. So, when we see dense breast tissue, it’s really important for the patient to be alerted and they are usually alerted through their physician that ordered the study to begin with--their mammogram--and have them return for bi-lateral breast ultrasound or bilateral tomosynthesis as another means as which for us to look at the breast tissue. It’s interesting that in our younger patients, you’re going to see much denser breast tissue because the breast tissue, at that point, is very hormonally responsive. There are all these hormones of estrogen and progesterone that are flowing through the body and they have an effect on breast tissue by causing this increased density. As we get older, the levels of estrogen and progesterone diminish and there, too, the degree of density of breast tissue diminishes. The reading of mammogram in the later years of life is a little easier than it is in the younger years of life but you never want to miss a breast cancer in a young person and that’s why we always recommend that women follow up with these other modalities so that we can look through and look at the breast tissue in a different way.
Melanie: Dr. Greatrex, what do you tell women when they ask you and they see in the media that certain organizations are even dis-recommending mammograms now or recommending them a little bit less frequently. What do you tell them when they ask you about this?
Dr. Greatrex: I find it to be very distressing because I diagnose women in their forties with breast cancer and to know that there’s a potential of missing it and not seeing it, or, not even that, but they never had a mammogram as a screening study beginning at age 40 and every year after that. Say, if they got breast cancer at the age of 40 or 42, or whatever, and we never did a mammogram. We would never know. What they’ve found is that when you consider the statistics in this country for breast cancer, one in eight women are going to get breast cancer in this country. You’re talking about not screening women on a yearly basis after the age of 40? We are going to miss breast cancers. Women are needlessly going to die. The lymph node involvement or the spread of the tumors will increase. The numbers of women that are going to need mastectomies will increase. The numbers of women that are going to need chemotherapy are going to increase. So, I am not an advocate of the changes that have been talked about. I believe that we should continue to do the screening as we have in the past every year after the age of 40. I think it should stand as that.
Melanie: Beautifully put and so well spoken, Dr. Greatrex. In just the last few minutes, give us your best advice for women and all of this terminology that we’ve gone through today about breast imaging and the breast imaging studies and the diagnostic tools that you use and why they should come to Lourdes Health System for their care.
Dr. Greatrex: I think it’s because we pride ourselves on treating the entire person. I always think about each patient and it’s not just the patient. It’s everyone in that patient’s lives that love them are impacted by what we do. We always take those things into consideration. I lost my mother to breast cancer when I was a medical student. She was 56. So, I come with a history that makes me very cognizant of the patients I take care of and the families that are affected by what the decisions I make for each patient. So, I think given that we have a very strong empathy here. I think also the fact that we’ve got amazing equipment--the best that you could have, we have here: 3D mammography, breast MRI, stereotactic biopsy, ultrasound-guided core biopsy capability. We can do everything and we have the trained professionals to do it. I‘m one of the few fellowship-trained breast imagers probably in this area. I trained at Memorial Sloan Kettering Cancer Center and I think it’s probably one of the finest centers in the world to learn about breast cancer, breast imaging. I pride myself on my knowledge, what I’ve learned and what I’ve brought here to Lourdes. I was born at Lourdes so I have a strong feeling about the place and certainly the type of care that we give I think is second to none.
Melanie: Thank you doctor so much. It’s great information. You’re listening to Lourdes Health Talk. For more information you can go to LourdesNet.org. That’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.