By Bonnie Rosenstock
In the ongoing war against breast cancer, going nuclear is proving to be an effective weapon. Joining Beth Israel Hospital’s arsenal of diagnostic modalities is Breast-Specific Gamma Imaging, or B.S.G.I., which has been recording impressive detection rates. According to Dr. Sheldon Feldman, chief of breast surgery at the Appel/Venet Comprehensive Breast Service (located in the Phillips Ambulatory Building at 10 Union Square East), it’s especially useful for patients who are at increased risk for developing breast cancer or who have difficult-to-read breast evaluations from mammography.
In Feldman’s soon-to-be published research paper, he reports that since he started using this new technology in November 2005, he has been able to change the management care of 20 percent of the first 300 patients to be screened with it. In patients who looked like they might have cancer, it turned out they didn’t, and patients who had benign-looking findings had breast cancer not detected in other, more conventional ways.
“Right now, often on a mammogram, there will be a questionable area, so a radiologist will recommend a biopsy, which is the standard of care,” explained Feldman. “Many will go on to have a B.S.G.I., which reads normal, even though the mammogram reads abnormal. So far, of all the patients we looked at, none of those who had a biopsy that showed an abnormal mammogram and a normal B.S.G.I. had a problem. Our hope is that it will save many, many patients from going through unnecessary biopsies,” he stated.
Feldman emphasizes that B.S.G.I. is a supplementary tool and doesn’t replace mammography, at least not yet. At present, it is recommended for women who are known to carry the breast cancer gene, for those with breast implants, very dense breast tissue and for patients with scar tissue from prior breast lumpectomy or changes caused by radiation.
“The paradox is the most likely place for breast cancer reoccurrence to develop is exactly where it started,” explained Feldman. “So, for somebody who had breast cancer, we liberally recommend this technology to pick up the possibility of a new problem that wouldn’t be seen on a mammogram.”
This is a different technology from mammography or ultrasound, which look at anatomical or structural abnormalities — shadows, calcifications or irregular densities. B.S.G.I. operates on a cellular or molecular level.
“We don’t really care how the things look on the picture,” noted Feldman. “We want to know if there are overactive cells in which you see any structural abnormality or change. It allows us the opportunity to make a much earlier diagnosis, just based on the metabolic activity.”
The Dilon 6800 camera and its B.S.G.I. technology, developed by Dilon Technologies, LLC, is basically a plate, which gently makes contact with the breast; unlike a mammogram, there is no painful squishing or compression. Like a mammography, two views of each breast are taken, one from the side, the other from the top. Except, instead of taking a picture, it’s detecting radioactive material, from an intravenous injection, that is concentrated in the breast tissue.
The plate can be rotated and adjusted. Each view takes about 10 minutes, plus the time it takes the radioisotope to reach the breast tissue. The patient sits on a chair during the entire procedure. A technician views it on a screen and adjusts for each view, while a radiologist at another station receives the images and immediately interprets them.
This technology is very much like nuclear medicine studies on other parts of the body. But the difference between this and an M.R.I. is that B.S.G.I. is much quicker, less expensive, more patient friendly (especially for those with claustrophobia) and easier to interpret. An M.R.I. requires very sophisticated software and specialized breast M.R.I. doctors to do it well.
“This makes for a fairly level playing field,” said Feldman. “Any hospital in the country that wants a secondary screening test for patients with breast disease can easily adapt to it.”
Beth Israel is the first and only medical facility in New York City to be equipped with B.S.G.I.
“We felt very early on that as this technology was getting perfected, it would be something of value for our patients,” said Feldman. “After a lot of arm-twisting, the administration agreed.”
The hospital has made a strong commitment to breast imaging and diagnostics by recently doubling its workspace capacity, newly installed on the third floor at Phillips. At some workstations, giant screens instantaneously receive digital mammography, which eliminates the wait time for film to go through a processor.
“You can manipulate the images of digital mammograms,” said Dr. Arifa Faiz, a radiologist mammographer, who is getting trained in the new system. “You can make them smaller, larger, rotate them, compare them in different positions, as well as compare them to previous studies in other modalities.”
Noted Feldman, “Many hospitals don’t provide these diagnostic services anymore because it’s very, very labor intensive and not particularly a moneymaker for the hospital. But it’s frontline basic service.
“The fact that Beth Israel gets it and is willing to do this is major.”
