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There’s not much in the way of healthcare, research or medical technology that gets past the University of Mississippi Medical Center (UMC).

In fact, it is usually a site that sets the pace for utilizing the latest in groundbreaking technology. Case in point, UMC is now one of the very few places in that nation using the Invivo DynaCAD™ magnetic resonance imaging (MRI) interpretation software system, which evaluates images and follows it up with an MRI-guided breast biopsy. It’s the latest tool in breast cancer detection for high-risk patients.

Siemens Medical Solutions and Invivo Corp., a subsidiary of Intermagnetics General Corp., announced the partnership that integrated Invivo’s computer-aided-detection (CAD) system with Siemens’ MAGNETOM MRI systems for advanced breast MRI technology. DynaCAD™ provides more detailed information for breast MRI exams to assist in detecting disease earlier and streamlining workflow. It is a digital imaging workstation with a comprehensive set of CAD tools for performing real-time image analysis and interventional procedure planning.

Although the final report isn’t in, the Mississippi State Department of Health estimated there would be 2,290 newly diagnosed breast cancer patients and 440 women would die from breast cancer during 2006.

The National Cancer Institute estimates that in 2007, there will be 178,480 new cases of female breast cancer nationwide, with 40,460 deaths. Men, who also get breast cancer, will account for an estimated 2,030 new cases, with 450 deaths. The new DynaCAD™ system will help pinpoint and enhance MRI breast exams.

Dr. Amy Coleman, UMC assistant professor of radiology, turned to the new method for her high risk and breast cancer patients.
“We do the MRI before surgery so we can plan the right surgery for her,” Coleman explained. “We’ll be adding patients with higher risk, expanding the role of MRI. We’ve just gotten a new MRI, a new breast coil and new software that helps us interpret the scan that we didn’t have initially. It helps us with findings and enhances your interpretation. Before, all we had was mammogram or ultrasound biopsies. We’ve used the MRI before, but now we have this enhanced interpretation software and have the ability to transfer it over to biopsy planning. We’re still going through learning curve and are hoping to add high risk patients as part of the routine.”

With the MRI-guided biopsy system, images can be more easily measured as far as shape, location, size, the blood-flow pattern and enhancement curve.  The breast coil is improved to be compatible with the software interpretation system.

In a news release, Nancy Gillen, vice president of Siemens’ MRI Division, said breast cancer is the most common malignancy among women in the United States and is second only to lung cancer in all cancer-related deaths.

“It’s essential to identify and administer treatment at an early stage. The combination of Siemens’ MRI technologies and Invivo’s CAD system will supply doctors with a powerful tool that enables them to diagnose breast disease in patients earlier,” Gillen said.
But, the DynaCAD™ system doesn’t replace mammograms.

According to the Centers for Disease Control and Prevention, screening mammography can reduce mortality from breast cancer by approximately 20-35 percent in women aged 50 to 69 years old and approximately 20 percent in women aged 40 to 49 years of age. Yet, in spite of numerous efforts to educate the public on the importance of mammograms for the early detection of cancer, mammograms are on the decline. The reason for the decline in screening mammography could be attributable to a combination of factors, but one study has indicated that breast-imaging facilities face challenges such as shortages of key personnel, malpractice concerns, and financial constraints.

Dr. Heather C. Bracey, UMC instructor in radiology, said the MRI-guided system should be used only after a mammogram due to the extreme sensitivity of the system and the unnecessary stress it could put on patients when it’s not necessary.

“It’s so sensitive, everything lights up and everything that lights up won’t be malignant. But, there’s no way to determine with 100 percent specificity if it is or isn’t,” Bracey said. “The MRI helps me determine if it’s a solid, but a lot of things that look like that are very vascular. If things light up, we’ll need to biopsy it and most turn out to be benign. Since we don’t have enough specificity to start screening the entire population with MRI, it’s not needed.

“It will worry a lot of women. It’s traumatic to go through a biopsy procedure and then have to wait five to seven days for a pathology report to come back. Putting them through all this emotion when you know that odds are it will be OK is not good.”

Bracey said it’s a great tool for patients who are at high risk, who have a known preoperative primary breast cancer, who have a strong family history of breast cancer, who are known BRCA1- or BRCA2-positive patients, or who have implant complications.

The procedure takes approximately 45 minutes. A special coil is placed around the patient’s breast and the chest is scanned with radiofrequency signals while computer software translates the information onscreen.

“The mammogram is good at saving lives and reducing the death rate. This is only recommended as an additional study after a mammogram, never first,” Bracey noted. “I don’t want people to think they have to have an MRI. The MRI shows enhancements the mammogram doesn’t, but the mammogram shows calcifications, which you need to look for. Those calcifications don’t show up on an MRI. MRI is great for a subset, but not for everyone yet.”

Thomas Tynes, director of Invivo’s Interventional MRI Business Group, said the addition of DynaCAD to the existing line of Siemens-certified Invivo breast MRI coils and biopsy systems “provides a comprehensive, fully-integrated approach to breast MRI diagnostics and intervention.”


June 2007

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