Stanford Hospital introduces 3D breast screening


A case in point is patient Sylvia Lew, who's a firm believer in the value of having an annual mammogram. But she says her first appointment turned into a nerve wracking ordeal after she received a follow-up phone call.

"They said we need you back to do more imaging. So I guess as all women, I freaked out. Is there a problem? They said, 'Well we don't know, there was a shadow,'" Lew remembers.

After spending the weekend worrying, Sylvia learned that the shadow was not cancer, but likely caused by her dense breast tissue, which can make standard imaging more difficult. This time around, she's turned to Stanford Hospital, and a different kind of breast imaging.

The technology is known as tomosynthesis. It's a form of x-ray that produces both two dimensional and three dimensional images in a single session. If doctors notice an area that's suspicious on the normal image, they can turn to the 3D view to essentially examine it from a different angle. Jafi Lipson, M.D. is Assistant Professor of Radiology at Stanford.

"The benefit of tomosynthesis is that you have multiple images at slightly different angles of the x-ray tube that allows you to resolve a lot of artifacts that we normally see when we take two dimensional images of the breast," Dr. Lipson explains.

A recent change in state law now requires doctors to notify women if they are diagnosed with dense breasts. But it's also touched off debate over the best way to screen those women. Laura Esseman, M.D. is a surgeon and breast cancer researcher at UCSF.

"Some people are advocating ultrasound, but ultrasound has a huge false positive rate. You find a lot of nodules, and you'll have 80 percent to 90 percent of those will turn out to be nothing and cause biopsies and a lot of anxiety," says Dr. Esserman.

She says another choice, MRI, is extremely effective for the highest risk patients, but can also produce false positives. She believes tomosynthesis has practical advantages for wide spread use.

"I think we're going to see that come forward as a better tool to either replace or supplement mammography, it would be the easiest to disseminate, and I think will not have anywhere near the false positive rate," she says.

Dr. Lipson says the current units deliver about the same amount of radiation as a routine mammogram.

"So tomosynthesis at the same time is becoming kind of a supercharged mammogram exam that gives us more sensitivity and specificity for women of all breast densities"

And in the case of women like Sylvia Lew, it saves them the anxiety of having to return for additional scans.

"It's definitely less scary for older women," Lew believes.

While the 3D system may offer specific advantages for women with denser breasts, Stanford is making the technology available to all women in their breast screening program.

written and produced by Tim Didion

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