3-D technology at Magee lessens mammogram recalls

Filed under Magee-Womens Hospital

By Pohla Smith, Pittsburgh Post-Gazette

Magee-Womens Hospital of UPMC has begun using new 3-D mammography technology after its study showed that it will reduce false recalls by 30 percent. It is also hoped to be able to find more cancers, particularly in women with dense breasts.

The Food and Drug Administration approved the use of Hologic Inc.'s digital breast tomosynthesis system last February. Approval is for use with traditional digital mammography, Magee said.

Initially, Magee is going to use it only for diagnostic patients rather than general screening, such as those with a new problem or coming in to see a radiologist for such conditions as a palpable abnormality, nipple discharge or recall, Jules Sumkin, chief of radiation at Magee, said Wednesday.

Breast cancer is the most common cancer to strike women. The foundation Susan G. Komen for the Cure estimates this year in the United States there will be 230,480 new cases of invasive breast cancer in women and 39,520 deaths.

But many more women go through the anxiety of worrying needlessly they have cancer because of recalls after mammograms that prove to be false positives.

"Recalls happen about 10 percent of the time," Dr. Sumkin said.

"A very small fraction of those actually have cancer," added Margarita Zuley, medical director of breast imaging at Magee.

"The most common reason for recall is overlapping tissue that is normal," she said. "Tomosynthesis ... eliminates the most common reason for recall."

In addition, she said, "we expect tomosynthesis will find more cancer." Those studies have not been published.

Much of the tomosynthesis research was conducted at Magee; its researchers are the most widely published group in the United States on the technology, UPMC said.

Tomosynthesis equipment looks like that used in digital mammogram, only instead of the X-ray tube staying still to take one image at a time, the tube moves and collects a series of pictures of 1 millimeter slices of the breast.

In an average breast of 4 to 5 centimeters, the radiologist reading the test would see a kind of movie of 40 to 50 images rather than the usual two 2-D views provided by digital mammography.

The old imaging "is not 100 percent sensitive," Dr. Zuley said. "It has a lower sensitivity for dense breasts." With its multiple images actually looking inside the breast, "tomosynthesis should help us with sensitivity in determining [cancer] in a dense breast because it eliminates the dense tissue hiding the cancer."

Since around 2006, the hospital has completed or is continuing about 10 studies, including some funded by Hologic, but also others supported by Komen and the National Institutes of Health, the doctors said.

"Advantages are much more apparent than any potential disadvantages," Dr. Sumkin said.

Disadvantages include some increased radiation exposure and the fact that radiologists need more time to read the new imaging, which will help lead to higher cost.

Dr. Zuley said the radiation exposure would be the same as that of digital mammography if tomosynthesis were used alone. But since it must be used with mammography, the level is twice the amount.

Still, Dr. Sumkin said, "it's an acceptable exposure of radiation as allowed by the FDA" for mammography.

Hologic provided initial prototypes for research, but by law medical centers must buy their own equipment for medical use, Dr. Sumkin said.

UPMC bought three of the machines, the prices of which were not immediately available but thought to be in the hundreds of thousands of dollars. Besides Magee's Oakland facility, there is one at Magee Womancare Center-Monroeville, and another will be at UPMC St. Margaret later this year or early next year.

The Oakland and Monroeville sites have screened a few hundred patients since beginning tomosynthesis Sept. 12.

Tomosynthesis will be an "additional charge, just like for an ultrasound" not just because the machine is expensive but because of the longer time the radiologist needs to read the images, the doctors said.

Magee did not immediately answer a question as to how much it is billing insurances for the imaging. Shireen Braner, administrative director of Breast Imaging at Magee, did say, "We currently use a miscellaneous billing code since the procedure is so new. CMS and other insurance groups are still contemplating payment structure." She said Magee anticipated that if the diagnostic work-up is covered, tomosynthesis used as part of the workup also would be covered.