News-Record.com

The following is a Counterpoint column.

By Elizabeth Brown, M.D.

I am writing about the article, "Clearer view of cancer," by Amy Dominello (News & Record, Feb. 14). I am concerned that the article is misleading and may have caused some confusion for your readers. I have already received many questions from patients and colleagues, and wanted to clarify some points about breast cancer evaluation.
Breast Specific Gamma Imaging is an interesting technology. Although the nuclear medicine agent Sestamibi is FDA approved and has been recognized as a breast imaging agent for some time, it is only recently that gamma cameras have been improved to allow detection of breast lesions smaller than 2 centimeters.

The current technique is very new and has yet to be proven effective in the detection of breast cancer in any large clinical trials. Small studies suggest that there may be a role for BSGI in the future, but it has not been adequately compared to mammography, ultrasound or MRI.

Currently, there is no data to imply that BSGI is as accurate as or more accurate than breast MRI. Large, well-designed trials will be needed to compare the modalities, but these studies have not yet been performed.

On the other hand, breast MRI has been studied for more than a decade and techniques continue to improve. Large studies have been performed which support the use of MRI for patients with newly diagnosed breast cancer and in screening patients at high risk for developing breast cancer.

MRI provides higher resolution images and additional anatomic detail when compared to BSGI. In addition, if a lesion is detected with MRI, a biopsy can be performed with MRI guidance for diagnosis. Currently, there is no way to perform a biopsy with gamma camera guidance, which can lead to problems if a lesion is discovered but cannot be identified on another imaging study for biopsy.

Despite these newer technologies, it is important to stress that mammography remains the gold standard for breast cancer screening. Large studies have repeatedly confirmed a survival benefit for women who undergo routine screening. And in a study of nearly 50,000 women, digital mammography, the newest type, shows improved breast cancer detection rate for women with dense breasts when compared to conventional mammography.

Unfortunately, we have no test that is 100 percent accurate in the detection of breast cancer. Numerous techniques are currently under investigation and hold promise for adding sensitivity and specificity to our current methods. But until each new technique is thoroughly investigated, it should not replace the modalities considered to be the standard of care.

This column also was signed by Drs. Dina Arceo, Caron Dover and Gretchen Green with Breast Center of Greensboro Imaging and Greensboro Radiology; Dr. Peter Young, Central Carolina Surgery; Drs. Robert Murray and Peter Rubin, Regional Cancer Center, and Dr. Arlene Libby, pathologist.