International Physician Update

Digital Clues to Breast Cancer

Digital mammography, notes radiologist Nagi Khouri, has the ability to detect timy lesions in the extreme dense breast tissue.

In a conventional mammogram X-ray, breast cancer as small as a pea can be detected. But about 10 percent to 15 percent of cancers may not be seen because of surrounding dense tissue.
Also, once an image is formed, it cannot be manipulated to improve visualization.

Johns Hopkins, however, is now using digital mammography in addition to conventional mammography to improve detection. Because digital allows images to be manipulated and enhanced on a high-resolution screen, explains radiologist Nagi Khouri, more tumors and smaller ones may be detected in even the densest breast tissue.

 “For women who have different types of tissue density, which appears from very whitish to very darkish, one picture does not give you optimal visualization,” Khouri says. “Digital allows you to brighten or darken, increasing the contrast to detect otherwise
hidden lesions.”

Khouri notes that digital mammography also allows quicker
examinations, fewer retakes and less radiation exposure to the patient. Digital mammograms can be sent electronically to radiologists who specialize in analyzing mammograms, of whom there is a shortage. The images can also be stored electronically, reducing the risk of studies being lost.

But more studies of the technology are needed, says Khouri, citing an upcoming clinical trial of some 40,000 women who will undergo both conventional and digital mammography to detect breast cancer. He adds that Hopkins also relies on other imaging modalities, including breast ultrasound to evaluate lumps, and MRI imaging to evaluate the extent of cancer within the breast.

“Some women have a negative mammogram but present with a lump in the armpit suspected to result from spread of a cancer from the breast,” Khouri explains. “MRI can detect the cancer originating in the breast, and as a result allow for better treatment options.”