Better breast test comes to Gnaden Huetten

When Cathy's* gynecologist found an area of abnormal tissue in her breast, she advised a mammogram, and then an ultrasound. But neither of the tests were able to tell doctors exactly what the area was.

"I had had some abnormal mammograms and abnormal biopsies several years ago. When I go for my routine mammograms and ultrasounds they always have an equivocal area that they are looking at," she said.

While her doctor didn't think the tissue seemed cancerous, she wasn't sure exactly. The mammograms and ultrasounds weren't making the picture any more clear.

So Cathy turned to a new technology that only recently became available at the Gnaden Huetten: Breast MRI.

Cathy said her gynecologist had recommended she have a breast MRI a year ago.

But the doctor's office staff told Cathy it was hard to get insurance companies to pay for the studies, so she put off the test.

"I've since learned that's not true," she said of the insurance companies.

When Cathy went back to her gynecologist, "she did another breast exam, looked at my reports, and said, you really need to have this done.

When she learned that Gnaden Huetten was getting the technology, she asked to be a "test" patient.

"And that's how we started the whole ball rolling," she said. Cathy first needed approval from her insurance company to pay for the test. "Serena (Rex) in MRI did a fantastic job. I think she was on the phone with them for a minute and got the whole thing approved. It was not a problem at all," she said.

Cathy had the test done in May. While it further defined the questionable tissue, she'll need another one in six months to make sure the tissue is not cancerous.

"They feel it's benign, but they don't want to let it go because the opposite could be very serious," she said.

The imaging staff prepared Cathy for the test, explaining how it worked, how long it would take (about an hour) and what would be involved.

Cathy would lie on her stomach on the MRI table, with her arms extended above her head and her face cradled in a soft, concave holder. She chose music pop/rock to listen to via earphones.

"I could have fallen asleep if they had allowed me to," she said.

The technicians spoke with her through the earphones, and she had an injection of contrast to highlight the blood vessels in the abnormal area of her breast.

"They definitely made you feel very comfortable, asking if you had any concerns, questions and getting you comfortable on the table," she said. "By the next day, my results were up and my doctor was contacting me within two days of that."

The procedure is new at Gnaden Huetten, used for the first time in April.

The technology "has been applied with increasing frequency over the past two decades. Over the past decade, it has been utilized not only for diagnostic purposes, but also for performing minimally-invasive breast biopsies," said surgeon Michael F. Martinez, MD, FACS.

"It's done using the needle-core technology, and using the MRI to guide us to the area of suspicion. Then using minimally-invasive techniques to extract the suspicious breast tissue through a large-bore needle," he said.

"Breast MRI is a new study that we've added to our arsenal of evaluation of breast pathology. It adds different information to our conventional studies of screening mammography, diagnostic mammography and ultrasound," said Blue Mountain Health System radiologist Joseph Zacher. "It allows us to delineate the lesions in a different sense."

"It looks at the breast tissue in a different way from either mammogram or ultrasound, and so it's used as an adjunct to those two studies. (which remain the core of how we image women's breasts)," Martinez said. "MRI has specific indications, which include imaging of younger women, who tend to have denser breast tissue, and when the diagnosis of breast cancer or a breast precancer has been made, to gain additional information about the extent of the disease in order to help direct the most appropriate therapy to enhance the chance for a cure with definitive surgery."

The study takes about an hour, depending on the case. "It's a very detailed study," Zacher said.

"One of the best uses for this to evaluate is, is a lesion vascular?" he said. "Which means, is it getting a lot of blood flow? If the lesion enhances in a certain fashion, it's suspicious for something that needs to be biopsied and removed. If the lesion doesn't have much vascularity, it's something that you may be able to follow and defer biopsy and surgery."

Cancerous lesions tend to have a greater blood supply.

Another way to use breast MRI is to "further evaluate breast cancer, especially with breast conservation therapy, where you do a local excision and perhaps some radiation therapy," Zacher said.

Breast MRI can show other sites of cancer that go unseen on mammograms because they are too small. It can also evaluate abnormalities that are "very far back in the breast that you may not be able to see on a mammogram. With a mammogram, you basically try to pull the breast out from the chest wall. It's just tough to get back there sometimes, and there can be something on the very edge of the image that you just can't see," Zacher said.

With breast MRI, "if it's there, you will see it," he said.

Blue Mountain Health System has formed a partnership with Foundation Radiology Group of Pittsburgh to read and interpret the breast MRI results.

"We have a specialty trained radiologist who does nothing but breast MRI interpretation, who will be reading our studies," Martinez said. "In the event that an abnormality is picked up, we have the capacity to perform MRI-guided breast biopsies, using minimally-invasive techniques."

The images are transmitted to Pittsburgh for the specialists there to read. The results usually come back within a week.

The Breast MRI offers physicians "another perspective that helps us make the best decisions as to what the woman needs," Martinez said.

"Half of all women in America will undergo breast biopsies at some point in their lives. It's a very common problem," he said. Breast biopsies are the second most common procedure he performs.

Martinez, who graduated from Hahnemann University School of Medicine, Philadelphia, is with Carbon Surgical Associates, PC., Lehighton.

"Blue Mountain offers all the most advanced technologies when it comes to treatment of both benign and malignant breast conditions," Martinez said.

(*Editor's note: Cathy did not want her last name used in the story.)