Scripps Green Hospital Offers New Breast Imaging Tool

When San Diego resident Joan B. was diagnosed with breast cancer, the news didn’t come as a surprise. In her mammoth family of 14, cancer had become common. Three brothers had prostate cancer.

Joan, then a 48-year-old registered nurse, was the third of five sisters who eventually received a breast cancer diagnosis. She had become next in a line of siblings forced to fight the disease, and she did so with a practical approach.

“Maybe coming from a big family made me more resilient and adaptable. But I typically deal with things head on,” said the nurse of 20 years. “I had it. I knew I had to deal with it — and I did.”

It was 2002, and Joan was already dealing with cancer nearly every day in her job. She worked as a radiation oncology nurse at Scripps Green Hospital, and was familiar with the journey she was about to embark on, which included two lumpectomies, chemotherapy and radiation.

At the five-year mark, Joan was considered cancer-free. She underwent routine screenings to make sure the disease had not returned. Then, her annual mammogram in December of 2008 produced an inconclusive result — and a scare.

The news isn’t all that uncommon for women like Joan. She was prone to calcifications, which often appear as abnormalities on mammography. Plus, she had fibrocystic or lumpy breasts.

“Dense tissue can make mammograms difficult to interpret,” said Marie Tartar, MD, director of Advanced Breast Imaging at Scripps Green Hospital. “This is a challenge we deal with frequently.”

A new nuclear imaging tool at Scripps Green Hospital helped to alleviate Joan’s concern. She underwent breast-specific gamma imaging (BSGI), which uses a maneuverable camera to capture high-resolution functional images of the breasts.

“I found out my cancer had not returned, and the procedure was a piece of cake,” said Joan. “There was minimal compression of my breast and I received the results right there, so I didn’t have to wait and worry.”

Unlike mammography, BSGI is not affected by tissue density. It is a molecular imaging procedure that evaluates the metabolic activity of breast lesions through uptake of an intravenously administered radioactive tracer.

Cancer cells absorb more of the tracing agent due to their higher metabolic activity and increased blood supply — so cancerous areas “light up” on BSGI.

“This modality is not a replacement for the annual mammogram,” said Dr. Tartar. “It is helping us overcome the limitations of conventional breast imaging, like mammography and ultrasound. And it is giving us another tool in the detection of breast cancer in some patients who need additional diagnostic testing.”

Magnetic resonance imaging (MRI) is typically the test used to identify malignant breast lesions after a murky mammogram. Evidence now suggests that BSGI has comparable sensitivity, superior specificity — and is more cost-effective than MRI. According to Dr. Tartar, the modality can be helpful when screening women at high risk — like Joan.

“BSGI is useful in imaging hard-to-evaluate patients, like those with dense breasts, implants, or scar tissue. It also helps when there is a question of feeling an abnormality, when nothing is seen on mammography and/or ultrasound,” she said.

“With a new or suspected diagnosis of breast cancer, BSGI can help assess the extent of disease, which helps in surgical decision-making.”

Scripps Green is the first and only health care facility in San Diego County with BSGI. But this isn’t the first time the hospital has been at the forefront of functional imaging for breast cancer. For two years, the breast imaging specialists at Green put a related technology to the test, participating in a multicenter prospective study looking at the staging of breast cancer using positron emission mammography (PEM).

Like BSGI, the device helps to detect suspicious cells based on the way in which they function, offering the potential for disease detection before an anatomic change develops on a mammogram or ultrasound.

“Functional imaging helps us fill the diagnostic gap when mammography or breast ultrasound is inconclusive, said Dr. Tartar. “Having BSGI at Green, we can get to the truth with fewer steps and reduce the number of unnecessary biopsies. That improves patient care.”

Now 56, Joan has turned her personal and professional experience into an opportunity to help women who receive a breast cancer diagnosis — or feel frightened after an inconclusive mammogram.

She is a breast care coordinator at Scripps Green Hospital, working side-by-side with patients to provide education and support. In her role, Joan helps women navigate the stressful road she’s traveled.

“I can help them realize there is life after a diagnosis. You can move on,” said Joan. “I can provide hope and help them find courage. It’s so rewarding.”