High-tech breast care

Patients benefit from new advances

Dr. Stephen A. Feig

Every day in the United States‚ thousands of women are screened for breast cancer while thousands more undergo treatment for the disease. Several new technologies employed by UCI Health, however, are easing the experience for patients while improving outcomes.

Three-dimensional mammography

A groundbreaking new screening and diagnostic exam that can detect breast cancer earlier and with greater accuracy than standard digital mammography is being used increasingly since it was approved by the Food and Drug Administration in 2011. It’s called breast tomosynthesis or three-dimensional mammography. Although it’s currently used for fewer than 10 percent of mammograms performed in the country, UCI Health has been offering 3-D mammography to its patients since January.

Three-D mammography allows doctors to examine tissues in much more detail compared to a traditional mammogram. That means detection rates will be substantially higher, says Dr. Stephen A. Feig, a UCI Health radiologist and internationally renowned expert on breast imaging and breast cancer diagnosis.

“Studies have demonstrated increases from 20 to 40 percent in detection of all cancers,” he says. “They’re even higher for invasive cancers: between 30 to 40 percent.” Research has demonstrated lower false-positive rates compared to traditional mammography. The greater accuracy of 3-D also means fewer women are called back for additional exams.

During 3-D, the machine moves around the breast, taking images of different layers of tissue at various angles. The computer then reconstructs these multiple low-dose images into a 3-D picture of the breast. While every patient can benefit from having 3-D mammography, the technology is especially valuable for women with dense breast tissue, Feig says.

“One of the challenges is that dense breast tissue can obscure abnormalities, similar to the way in which a pool clouded by algae prevents you from seeing fish swimming under the surface,” he says. “Three-D solves this problem by revealing abnormalities hidden beneath ‘masking’ layers of tissue in dense breasts. With 3-D technology, we can see even the smallest abnormalities.”

Precision lumpectomy

The goal of breast-conserving lumpectomy is to remove all detectable cancer cells while sparing as much healthy tissue as possible. But of the estimated 174,000 women who have breast conservation surgery every year, about 30 percent will require a repeat procedure because cancer cells are not completely removed during the initial surgery.

UCI Health surgeons are the first in Orange County to use SAVI Scout®, a system that better targets the tumor, increasing the chances of complete cancer removal, says Dr. Alice Police, a surgical oncologist and medical director of the UCI Health Pacific Breast Center. The system, which is approved by the FDA, uses a probe that emits non-radioactive, electromagnetic waves to detect a micro reflector placed in the target tissue. The reflector can be inserted into the target tissue up to a week before surgery. Using the probe, the surgeon locates the reflector and plans the incision. The excised tissue is scanned with the probe to confirm the sensor has been removed.

UC Irvine Medical Center is the only hospital in Orange County to participate in a national, multicenter clinical trial of the SAVI Scout system. “My focus is always on finding a better breast cancer operation,” Police says. “Precise location of the tumor is crucial for a shorter operation time, smaller incision, speedier recovery and to avoid another surgery.”

Removing every trace of the tumor

UCI Health surgeons are the first in the nation to use a device that may reduce the need for a second surgery to remove breast cancer cells missed during an initial lumpectomy. The MarginProbe® system lets the surgeon immediately assess whether cancer cells remain on the margins of excised tissue and remove more tissue, if necessary. Currently, patients have to wait days for the results of a pathology test to see whether the first surgery completely eliminated the tumor.

“Many of my patients know someone who has had to go back into surgery because their doctor didn’t get the entire tumor out,” Police says. “The ability to check tissue in the operating room is a game-changer in surgery for early-stage breast cancer.” Studies show the MarginProbe system reduced repeat surgeries by 56 percent. The system comprises a sterile handheld probe and a portable console.

The probe emits radiofrequency signals onto the excised lumpectomy specimen. The reflected signals are analyzed using a specialized algorithm to determine whether the tumor margin contains cancer cells.

Another advance that both improves outcomes and increases patients’  comfort is a system that allows for a concentrated dose of radiation therapy at the time of surgery. Intraoperative radiotherapy (IORT) saves some women from daily rounds of radiation therapy after surgery and spares them the side effects that accompany it. Typically, women who require radiation therapy undergo up to six weeks of treatment after surgery.

Certain women who have early-stage breast cancer could benefit from receiving a single dose of radiation right in the operating room, during the lumpectomy,” Police says.

UCI Health has two convenient locations in the Newport Beach area and in Orange that offer a variety of breast health services. For more information or to make an appointment, visit ucirvinehealth.org/breast.

— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Fall 2015