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New Tool May Detect Breast Cancer Quickly

Might tell in minutes if abnormality is malignant

THURSDAY, Sept. 26, 2002 (HealthDayNews) -- Australian researchers have developed a technology that may bring the world a step closer to providing "one-stop shopping" for women who suspect they have breast cancer.

The technology might one day be able to tell, within minutes and without any kind of surgery, if a breast abnormality is benign or malignant --and if it's malignant, whether there is lymph node involvement.

"It is still preliminary but the potential is tremendous," says Dr. Carina Biggs, head of the breast center and of breast surgery at Maimonides Medical Center in New York City. "The ability to make a diagnosis of cancer within a short time in a noninvasive fashion is the goal for patients who present at a breast center. This would prevent unnecessary trips to the operating room."

The researchers presented their findings today at the "Era of Hope" Department of Defense Breast Cancer Research Program in Orlando, Fla.

Currently, women who detect an abnormality in their breast usually need a surgical biopsy to determine if the mass is benign or malignant. The answer can take several anxious days to arrive.

If the answer does come back positive, the woman will likely need to have all or some of her lymph nodes surgically removed to see if the cancer has spread. This procedure can cause lymphedema, or swelling in the legs or arms.

The Australian team used magnetic resonance spectroscopy (MRS) to analyze the chemical composition of cells removed from the suspicious area of the breast, as well as mathematical algorithms to determine if the cancer had moved to the lymph region.

MRS is a "functional imaging" device, meaning it is able to look at the biochemical composition of cells and determine what they're doing. In this case, the MRS was used to look specifically for increases in the amount of choline, a chemical that can be associated with the presence of cancer.

In the first study, which involved MRS without the mathematical analysis, the MRS detected breast cancer in samples from 108 women with 94 percent sensitivity and 95 percent specificity. (The term "sensitivity" refers to the proportion of people with disease who tested positive while "specificity" refers to the proportion of those free of the disease who came back with a negative result.)

In subsequent studies, the cells were also subjected to a mathematical analysis to determine if the cancer had spread to the lymph nodes. Here the researchers found 96 percent sensitivity and 94 percent specificity.

So far, all the research has been "ex vivo," meaning outside of the body. The next step is to replicate the studies in vivo and compare the two sets of results.

"Doing it ex vivo on cell samples is, in a way, safer because we're getting more information. We're seeing more of the chemical information that is available than in vivo," says Cynthia Lean, a member of the research team and scientific director of the Institute for Magnetic Resonance Spectroscopy in Sydney, Australia.

The accuracy of the results will depend largely on the power of the MRS. At 1.5 Tesla, the researchers were able to distinguish between benign and malignant tumors but the sensitivity and specificity were not as good -- there wasn't enough chemical information. "At three Tesla, we hope we will get more chemical information," Lean says.

The possibility of using magnetic resonance spectroscopy in conjunction with mammographies to detect breast cancer earlier is also being investigated.

Right now, the Australian researchers view their technology as an adjunct to lymph node biopsies.

"At the moment, we see that technology being used as an adjunct to central and node biopsy," Lean says. "But ultimately we would like see if we could get that information in vivo. We know from the ex vivo studies that the prognostic information is there. It's a matter of how fast the technology will catch up with being able to access it."

Clinical (in vivo) testing of the technology is supposed to start within the a year at sites in Australia, Sweden, and the United States. The U.S. sites include Beth Israel Deaconess Medical Center of Harvard Medical School.

What To Do

For more information on MRS and breast cancer detection and diagnosis, visit the National Breast Cancer Centre Australia. For more on breast cancer, see this American Cancer Society site.

SOURCES: Carina Biggs, M.D. director, breast center and chief, breast surgery, Maimonides Medical Center, Brooklyn, N.Y.; Cynthia Lean, Ph.D., scientific director, Institute for Magnetic Resonance Spectroscopy, Sydney, Australia; Sept. 26, 2002, "Era of Hope" Department of Defense Breast Cancer Research Program, Orlando, Fla.
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