EH 2_2016

RADIOLOGY 2-D/3-D scaled for 360-degree breast biopsies Towards personalisation of ovarian cancer care NEW: The dedicated prone breast biopsy table Imaging the invisible killer Breast tomosynthesis imaging, Holo­ gic calls it 3-D mammography, is proving to be the best modality to image breast cancer. ‘The Hologic tomosynthesis system has dem- onstrated superior clinical perfor- mance to conventional 2-D mam- mography in a number of metrics, in particular showing improved detec- tion of invasive cancers and reduc- tions in recall rate,’ the manufactur- er reports, adding: ‘Now Hologic is offering its tomosynthesis technol- ogy on a dedicated, prone breast, biopsy table. ‘The CE-marked ‘Affirm’ prone biopsy table provides enhanced 2-D/3-D biopsy imaging and fast, easy access to the breast,’ Hologic points out. ‘The new product is an important step forward in biopsy technology — allowing radiologists to better target lesions found with 3-D mammography exams, as well as other screening modalities — with exceptional imaging, improved workflow and seamless, 360-degree access to the breast.’ Clinicians trust prone patient posi- tioning for breast biopsy because it supports the patient stably through- out the procedure while isolating them from the biopsy needle – cer- tainly improving patients’ experi- ence. The Centro de Patologia de la Sascha Keutel reports For many cancers there has been a steady improvement in patient out- comes, due mainly to early detec- tion and novel therapies. However, with ovarian cancer, the most lethal gynaecological cancer in Europe, no such success can be reported. The major problem with ovarian cancer is detection because, in the early-stage, the disease is rarely symptomatic and screening is not supported by trial evidence. Most patients present with disseminated peritoneal disease that can be sur- gically complex, Professor Rockall explained and added that CT is still inconsistent to predict surgical find- ings, which limits its contribution only to surgical planning. Another problem, according to Professor Rockall, is that the initial response to chemotherapy is often followed by disease relapse, which then develops resistance to the treatment: ‘A better understanding of this disease is urgently needed and imaging developments have an important role to play.’ The radiologist offered several suggestions to improve early detec- tion, such as MRI-supported ultra- sound, which may lead to successful screening and a radiological lexicon. Rockall introduced an algorithmic approach for the characterisation of masses, which is currently being val- idated in large multi-centre studies. Furthermore, the professor intro- duced current radiomic studies that are exploring imaging characteris- tics of underlying tumour biology. They aim to stratify ovarian cancer into distinct gene expression sub- types that may enhance therapeutic targeting. ‘I hope I could convince you that imaging can personalise chem- otherapy. Early detection of non- responders using advanced imaging techniques and potentially radiom- ics may play a significant role in the future. Imaging can indeed per- sonalise the planning of surgery. The challenges of CT, which are very real, may be overcome through multiparametric MRI allowing opti- misation of the surgical approach’, Professor Andrea Rockall concluded her presentation. * The Royal Marsden Hospital was founded by Dr William Marsden in 1851 as the Free Cancer Hospital, was the first hospital in the world dedicated to the study and treat- ment of cancer. Mama, Tejerina Foundation, in Madrid, Spain became one of the first sites in the world to offer the new system. Alejandro Tejerina MD, a radiologist with the Centre, reports that the feedback from the first wave of patients is very positive. ‘We are performing these [prone biopsy] procedures now with an average of 20 minutes,’ he said. ‘That’s a big change, not only for our time but also for the patient experience. I have a colleague in the Netherlands who also had one of the first sys- tems installed, and she said she did one procedure in just 12 minutes. That is perhaps exceptional, but it shows what is now possible.’ According to Tejerina, conven- tional breast biopsy systems are restricted to 2-D imaging with a narrow window for targeting the lesions. Often it requires multiple X-ray exposures to find and position the suspect tumour for the biopsy needle. With tomosynthesis imaging on the new Affirm table, he said there is a much wider field of view and, critically, the biopsy device can now be positioned anywhere in a 360-degree circle. Hologic built many other innova- tive features into the new Affirm prone system that make it easier to work with and faster for the proce- dure, Tejerina noted. The Hologic MultiCare Platinum system had to be positioned manu- ally, ‘now the system does this for us automatically, which saves time. The software really streamlines our workflow, so that goes faster. The paddles for compressing the breast are clear instead of metal, and this makes things easier.’ Even the positioning of the patient improves the experience, he said. With upright systems, the woman undergoing the biopsy is looking directly at the biopsy needle. If the woman is lying down, she dos not need to witness the procedure directly. The new Affirm prone system offers a more efficient, more accu- rate procedure and the woman’s breast is under compression for less time, which adds to her comfort, he said. The Foundation has led the way in women’s breast health for over 40 years. Offering tomos- ynthesis guided breast biopsies on the Affirm prone 2-D/3-D biopsy table is another first for the Centre, Hologic pointed out. ‘In 2000, the Centre pioneered the use of digital mammography in Spain. It was the first centre to install a stereotactic guided prone biopsy table in 1997. ‘In 2010, it led the way again, installing a Hologic Selenia Dimensions breast tomosynthe- sis system, the first site in Spain to use the innovative technology to improve the early detection of breast cancer. Later in 2010, the Centre was the first site in Spain to combine the Hologic Affirm upright biopsy system with the Hologic tomosynthesis system. ‘In 2015 the Centre began offering Hologic’s I-View contrast enhanced 2-D imaging along with a 3-D scan, further increasing the value of a contrast mammography procedure. ‘The Affirm prone biopsy sys- tem expands the Centre’s breast biopsy portfolio, complementing their Selenia Dimensions 2-D/3-D mammography system and Affirm upright biopsy system,’ Hologic con- cludes. Among the first to provide tomosynthesis guided breast biopsies on the new Hologic Affirm prone 2-D/3-D biopsy table are Alejandro Tejerina (second from left) and colleagues at the Centro de Patologia de la Mama, Tejerina Foundation, Madrid Andrea G Rockall, Consultant Radiologist at the Royal Marsden Hospital and Visiting Professor of Radiology at Imperial College in London, delivered the prestigious Wilhelm Conrad Röntgen Honorary Lecture at ECR 2016 on ‘Imaging the invisible killer: towards personalisation of ovarian cancer care’. Andrea G Rockall is a Consultant Radiologist at the Royal Marsden Hospital* and Visiting Professor of Radiology at Imperial College in London, UK. She graduated from King’s College Hospital, London, in 1990 and received her radiology training at St Mary’s Hospital and University College Hospital, London. The professor was president of the International Cancer Imaging Society for 2015 and is a member of numerous organisations, including the British Gynaecological Cancer Society, the RCR and the National Cancer Intelligence Network. © BlueRingMedia / Shutterstock.com 22 EUROPEAN HOSPITAL  Vol 25 Issue 2/16

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