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New Advances in Imaging are Making Cancer Growth Easier to Find


The big daddy of cancer imaging is Biograph TruePoint, a new PET/CT scanner that creates hi-def images of the entire body. In about 20 minutes, it creates 16 images that radiologists piece together for a complete evaluation. Biograph TruePoint is in use at Delaware County Memorial Hospital, Springfield Hospital and Crozer-Keystone Regional Cancer Center at Brinton Lake in Glen Mills. “The previous PET/CT was a six-slice scanner,” says Dr. Thomas DiLiberto, chairman of radiology at Delaware County Memorial Hospital. “Previously, we could do one centimeter, and now we can do .4 centimeter. We can get more images at better resolution and faster.”

In treatment, Biograph TruePoint acts like a cancer GPS, directing oncologists to the portions of the tumor that need radiation or surgical excising. “In the past, we didn’t have the PET technology incorporated into our treatment,” says Dr. Khozaim Nakhoda, director of nuclear medicine at Crozer-Chester Medical Center. “Now, the tumor’s position is fed into the machine, and we can see the extent of the tumor—the part of it that’s metabolically active and therefore malignant, and the part that’s not.”

Detecting what’s malignant and what’s not in breast tissue is easier because of digital breast tomosynthesis, the newest form of mammography. It uses digital technology—and very low doses of radiation—to create a series of images that compose a high-def 3-D rendering of the breast. DBT allows radiologists to essentially see through layers of breast tissue. “It’s the most exciting change in my career,” says Dr. Emily Conant, chief of breast imaging at Penn Medicine.

Here’s how DBT works. A female patient stands in the standard position, with one breast in compression. The DBT machine moves around her in a 15-degree arc. Each image capture takes three seconds. The overall scan takes perhaps a minute longer than a standard mammogram. The technician uses the images to create both 2-D and 3-D versions of each breast.

Penn’s Perelman Center for Advanced Medicine and Einstein Medical Center are among the few places where DBT is available; both participated in the technology’s clinical trials. “We’ve been shocked by the cancers we now see that we didn’t see with 2-D digital mammography,” Conant says. “And, of course, the earlier we catch breast cancer, the better we
can treat it.”

DBT has another benefit: reducing false positives. Its 3-D images allow physicians to better distinguish between anomalies that are cancerous and those that aren’t. Conant credits DBT with significantly reducing callbacks, and she believes it will counter the negativity surrounding mammograms.

“If we get it right more often, more women will get them,” says Conant. 

Conant is so convinced of DBT’s efficacy that, after its FDA approval in late 2011, she made it the go-to mammography technology for all Perelman patients. “Insurance doesn’t cover the increased cost of tomosynthesis, but we offer it without being reimbursed because we have the technology, it works and it’s the right thing to do for our patients,” she says.

DBT, however,  is only one technology in breast imaging’s quiver of cancer detectors. “All of the existing screening tools are complimentary,” says Conant. “It’s not one test fits all. Figuring out how to personalize screening based on age, risk and breast type is our next step.”

While CT/PET scans and DBT screen for what’s beneath the skin, MelaFind scans what’s on it. Approved by the FDA in November 2011 and just now finding its way into area dermatologists’ offices, MelaFind uses the light of 10 different wavelengths to detect melanoma. Passing a hand-held, grocery scanner-type tool over suspicious moles and freckles feeds information into a computer that uses it to create 3-D images. Most important, MelaFind goes where dermatologists’ eyes can’t: 2.5 millimeters beneath the skin’s surface.

“It can also magnify the mole so that I can see its borders, their irregularities and textures,” says Dr. Erum Ilyas of Montgomery Dermatology in King of Prussia. “The goal is to cut down on unnecessary biopsies.”

But Ilyas cautions that MelaFind isn’t appropriate for use with every mole—or by non-dermatologists. Her examinations still begin with a dermatoscope, a hand-held magnifying lens with a light attachment. That allows Ilyas to do topical skin evaluations in which she looks for moles and freckles that have irregularities in their asymmetry, borders, color or diameter.

Should any suspicious moles be found, Ilyas uses MelaFind to scan them. “It compares the mole to 72 features of moles known to be problematic,” she says.

But MelaFind is only as smart as the mole you direct it to. “If I position it over a pencil mark on a piece of paper, it doesn’t know that’s not human skin,” Ilyas says. “The operator has to point MelaFind in the right place, or it will give false information.”

Ilyas’ patients think MelaFind is pretty cool. “It takes just a few minutes to get that image and data report, and people do feel comforted when MelaFind gives them more information about a suspicious mole,” she says. “I use it mostly to confirm my findings. The machine usually agrees with me.”