National Cancer Institute - NCI Division of Cancer Treatment and ...
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Digital Mammograms May Benefit Some Women: Results from the Digital Mammographic Imaging Screening Trial http://www.cancer.gov/dmist As part of its role to evaluate new imaging technologies, CIP funded the Digital Mammographic Imaging Screening Trial (DMIST) to determine whether digital mammography is as good as, or better than, conventional screen-film mam- mography in detecting breast cancer, the second most common cancer among U.S. women. Although only approximately 8 percent of breast imaging units in the United States provide digital mammography, the technology is becoming more common. One of the concerns surrounding greater use of digital mammography is its cost, with digital systems currently costing approximately 1.5 to 4 times more than film systems. Digital mammography may offer advantages over conventional mammography because: ■ The images can be stored and retrieved electronically, making long-distance consultations with other mammography specialists easier ■ The images can be electronically adjusted by the radiologist, and subtle differences between tissues may be noted ■ Digital mammography may reduce the number of necessary follow-up procedures Standard film mammography has been used for more than 35 years and is very S C I E N T I F I C A D V A N C E S effective, but it is less sensitive for women who have dense breasts, a population at higher risk for breast cancer. Prior studies suggest that approximately 10 to 20 percent of breast cancers detected by breast self-examination or physical examination are not visible by film mammography. Until DMIST, there were only some limited studies that showed no significant difference in the performance of digital mammography vs. film mammography. DMIST was purposively designed to measure relatively small, but potentially clinically important, differences in diagnostic accuracy between digital and film mammography. DMIST researchers are also assessing the relative cost-effectiveness of both technologies and their effect on patient quality of life. The American College of Radiology Imaging Network (ACRIN), a research network funded by CIP, is conducting the study. A comparison of digital and film mammography (left: digital; right: film). The questionable area, just below the nipple, is more easily visible in the digital image. University of North Carolina Lineberger Comprehensive Cancer Center. C A N C E R I M A G I N G P R O G R A M ■ 61
Dr. Edward A. Neuwelt, Oregon Health & Science University. In 2005, results from DMIST showed no difference in detecting breast cancer for the general population of women in the trial. However, women with dense breasts, who are pre- or perimenopausal (women who had a last menstrual period within 12 months of their mammograms), or who are younger than age 50 may benefit from having a digital rather than a film mammogram. The results were reported September 16 in a special online publication of the New England Journal of Medicine and at the 2005 annual meeting of ACRIN. The results of this large clinical trial of about 50,000 women, led by Drs. Etta D. Pisano, University of North Carolina at Chapel Hill, and Edward Hendrick, Northwestern University, will give clinicians better guidance and greater choice in deciding which women would benefit most from various forms of mammography. 30 minutes after gadolinium 24 hours after ferumoxytol MRI in the operating room 26 hours after ferumoxytol 62 ■ P R O G R A M A C C O M P L I S H M E N T S 2 0 0 6 ■ ■ ■ Digital mammography images can be electronically adjusted by the radiologist, and subtle differences between tissues may be noted. Magnetic resonance images of a patient with high-grade brain tumors. The ferumoxytol shows larger areas of the three tumors and can also be seen on a special magnetic resonance machine used in the operating room without giving more contrast agent. The larger target volume of the tumors at surgery and the persistent enhancement allows the surgeon to see if all the tumor has been removed during the operation. Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, Conant EF, Fajardo LL, Bassett L, D’Orsi C, Jong R, Rebner M; Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 2005:353;1773–83. Pilot Study Evaluates Use of Ferumoxytol in Magnetic Resonance Studies of Brain Tumors A CIP-funded pilot study at Oregon Health & Science University is investigating the potential role of ferumoxytol in the evaluation of malignant brain tumors. Ferumoxytol is an iron oxide nanoparticle that targets phagocytic cells and can be used for MRI of pathology that has a significant phagocytic component. The investigators compared ferumoxytol imaging, perfusion, and magnetic resonance angiography (MRA) with gadolinium imaging. The results from this pilot study of 12 patients with brain tumors indicated that, after administration of ferumoxytol, the tumors were detectable on magnetic resonance studies at various field strengths, including an intraoperative 0.15-Tesla magnet. In addition, there was less early leakage out of the blood vessels after injection of ferumoxytol in comparison to gadolinium. Further investigations are required to evaluate whether magnetic resonance studies with ferumoxytol would be superior or complementary to studies with gadolinium for assessing tumor perfusion and predicting tumor response to therapy. Neuwelt EA, Várallyay CG, Manninger S, Solymosi D, Haluska M, Hunt MA, Nesbit G, Stevens A, Jerosch-Herold M, Jacobs PM, Hoffman JM. Potential of ferumoxytol nanoparticle in MR imaging, perfusion, and angiography of CNS malignancy. Manuscript in preparation.
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Digital Mammograms May Benefit<br />
Some Women: Results from the<br />
Digital Mammographic Imaging<br />
Screening Trial<br />
http://www.cancer.gov/dmist<br />
As part <strong>of</strong> its role to evaluate new imaging<br />
technologies, CIP funded the Digital<br />
Mammographic Imaging Screening Trial<br />
(DMIST) to determine whether digital<br />
mammography is as good as, or better<br />
than, conventional screen-film mam-<br />
mography in detecting breast cancer,<br />
the second most common cancer among<br />
U.S. women.<br />
Although only approximately 8 percent <strong>of</strong><br />
breast imaging units in the United States<br />
provide digital mammography, the technology<br />
is becoming more common. One<br />
<strong>of</strong> the concerns surrounding greater use<br />
<strong>of</strong> digital mammography is its cost, with<br />
digital systems currently costing approximately<br />
1.5 to 4 times more than film<br />
systems. Digital mammography may<br />
<strong>of</strong>fer advantages over conventional<br />
mammography because:<br />
■ The images can be stored <strong>and</strong> retrieved<br />
electronically, making long-distance<br />
consultations with other mammography<br />
specialists easier<br />
■ The images can be electronically<br />
adjusted by the radiologist, <strong>and</strong><br />
subtle differences between tissues<br />
may be noted<br />
■ Digital mammography may reduce<br />
the number <strong>of</strong> necessary follow-up<br />
procedures<br />
St<strong>and</strong>ard film mammography has been<br />
used for more than 35 years <strong>and</strong> is very<br />
S C I E N T I F I C A D V A N C E S<br />
effective, but it is less sensitive for women<br />
who have dense breasts, a population at<br />
higher risk for breast cancer. Prior studies<br />
suggest that approximately 10 to 20 percent<br />
<strong>of</strong> breast cancers detected by breast<br />
self-examination or physical examination<br />
are not visible by film mammography.<br />
Until DMIST, there were only some limited<br />
studies that showed no significant difference<br />
in the performance <strong>of</strong> digital mammography<br />
vs. film mammography. DMIST<br />
was purposively designed to measure<br />
relatively small, but potentially clinically<br />
important, differences in diagnostic<br />
accuracy between digital <strong>and</strong> film<br />
mammography.<br />
DMIST researchers are also assessing<br />
the relative cost-effectiveness <strong>of</strong> both<br />
technologies <strong>and</strong> their effect on patient<br />
quality <strong>of</strong> life. The American College <strong>of</strong><br />
Radiology Imaging Network (ACRIN),<br />
a research network funded by CIP, is<br />
conducting the study.<br />
A comparison <strong>of</strong> digital <strong>and</strong> film mammography (left: digital; right: film).<br />
The questionable area, just below the nipple, is more easily visible in the<br />
digital image.<br />
University <strong>of</strong> North Carolina Lineberger Comprehensive<br />
<strong>Cancer</strong> Center.<br />
C A N C E R I M A G I N G P R O G R A M ■ 61
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