Targeting Needless Breast Biopsies

Think mammograms are unpleasant? Breast biopsies are much worse. Any woman who's had one to determine whether a lump is benign or malignant will attest to that. Even with minimally invasive techniques, the doctor has to guide a needle to the spot to localize the lump before inserting small blades to sample the tissue. "You definitely feel it," says Donna Feo, 42, of Columbiana, Ohio, who had the procedure in February. "You have bandages on your breast for a week or so." Then there's the tense wait for the results. For Feo, that meant four days during which she agonized over the prospect that her small children would be left without a mother. Some 1.4 million women undergo breast biopsies in this country every year. And after all that grief, 80 percent of the lumps turn out to be benign ... like Feo's. Isn't there a better way?

Soon there may be. Last week at the Radiological Society of North America, Dr. Richard G. Barr, director of ultrasound breast imaging at Southwoods X-Ray and Open MRI in Boardman, Ohio, presented a study on a new ultrasound technique called elasticity imaging. The procedure exploits a simple characteristic of malignant tumors: they're harder than benign ones. "The body attempts to wall them off, so it builds up a fibrous area around the lesion," says Barr. The new technique, which handily separates the stiff from the soft lumps, is so painless and unobtrusive that patients can't tell the difference between that and a regular ultrasound scan. And the results are available immediately.

To perform the scan, the radiologist moves the ultrasound handpiece over the affected area. The special system continuously records two images--the standard ultrasound picture and the elastogram--which the adjoining monitor displays side by side. Softer tissue that moves with gentle pressure is shown as white on the elastogram, while stiffer tissue is black. As a result, a benign lump appears smaller on the elastogram than on the regular ultrasound, while a malignant lump appears larger. A simple comparison of the two images shows which lumps are suspicious.

Early tests have been impressive. Barr studied 123 lesions with the new technology before performing standard biopsies to confirm the results. Of the 123, 17 proved to be cancerous upon biopsy. Elasticity imaging had predicted all 17 accurately. Of the 106 that were benign, elastograms showed 105 as benign, with the other looking malignant. A false positive like that would send a woman for a needless biopsy, but it wouldn't let any cancers escape detection. Larger trials are needed to confirm the results. Barr is leading a new multicenter trial of 1,000 to 2,000 women. But other radiologists are skeptical. "I suspect that once larger numbers of women are tested, it will become apparent that there are exceptions that don't follow the pattern," says Dr. Ralph Wynn, clinical director of breast imaging at Memorial Sloan-Kettering Cancer Center in New York.

Still, the technology has already benefited Donna Feo. For anyone worried about the accuracy of a biopsy, she says, "This provides total peace of mind." And if one day it can eliminate thousands of needless biopsies, too, she says it will be nothing short of a godsend.