Other Diagnostic Studies

A wide variety of technologies have been utilized and under development to improve our ability to detect breast cancer early.  These are some that are currently under investigation and show promise for the future.

Note:  None of these techniques are a replacement for standard breast cancer detection tools such as mammography or physical exam.  They should only be used as an adjunct to these methods.

Electronic Palpation

A lump that can be felt in the breast is still an important possible sign of breast cancer. Unfortunately, physical examination remains somewhat subjective, differing from examination to examination and examiner to examiner.

Some very innovative researchers have utilized research from advanced robotics laboratories and created a device with hundreds of microsensors on its surface.  This can be used to create a three dimensional "map" of the breast tissue, providing better documentation of size and "hardness" of the lump, which can be objectively compared from visit to visit. 

This device, marketed under the name of SureTouch, is FDA approved for documentation of breast masses, and is currently under evaluation at several specialized centers (including Massachusetts General, Bellingham Breast Center and the Breast Center of Southern Arizona.)  Click here for more information.

Ductoscopy

Breast ductoscopy is a new endoscopic technology that gives physicians the ability to view abnormalities from within the milk ducts of the breasts. Most breast cancers originate in the tiny milk ducts of the breast and grow slowly over 10 to 15 years. They remain undetected until they are large enough for conventional techniques such as mammography, MRI or ultrasound to diagnose. These techniques require that the lesion grow to more than 5mm in diameter. Ductoscopy was designed with the hope that it would consistently identify these smaller, occult tumors.

Studies show that while this is sometimes possible, additional research is still required before this technology will become part of the standard evaluation of breast conditions.  Currently, it is most useful in evaluation of symptomatic, bloody nipple discharge (although it has not yet replaced the need for surgical removal of the involved ducts.)  Click here for more information.

Positron Emission Mammography

Although film screen mammography is currently the best way to detect breast cancer, both the sensitivity and specificity of this technique are limited.  The sensitivity of mammography is approximately 88% for detectable breast cancer. The remaining twelve percent are typically detected at physical exam.  Moreover, the specificity of mammography is much lower than its sensitivity, approximately 15-35%; thus many women are subjected to breast biopsies for benign lesions.  Mammography is inherently limited in its ability to detect breast cancer because it relies on demonstrating morphologic differences between cancer and benign lesions.

Positron Emission Mammography uses injected radioactively "tagged" sugar-like molecules (called FDG) to mark or make visible tissue which is more likely to be cancerous. The cancer tumors accumulate more of the radioactive tracer which appears to the tissue as if it is glucose or sugar, a source of much needed energy for growth. Since tumor cells are growing more quickly than healthy tissue the cancer shows up as "hot" spots in the PEM images.  Click here for more information.

Ductal Lavage

Breast most breast cancers begin in the lining of the breast ducts, researchers speculated that if we could sample ductal cells from the inside of the ducts, it might be possible to detect breast cancer very early.  This would be similar to the way a Pap test works for gynecologic cancers.  A small catheter was developed to do just this though a technique called "Ductal lavage".

A very small catheter is inserted into breast ducts, and cells are "washed" out of the duct.  These cells are then analyzed under a microscope by a cytopathologist who determines whether they are normal, atypical, or malignant.   Although studies have not yet shown this to work as a screening tool for breast cancer, it can help in management of patients who are known to be a high-risk for breast cancer.   Additional studies are in progress to determine how this technique will be most useful.  Click here for more information.

Thermography

For centuries, physicians have known that cancers are "hotter" than surrounding tissues due to increased blood flow.  This has led to the hope that detection of areas of increased temperature could help detect cancers before they were seen on mammogram or had formed a lump.  Despite years of research, this has not yet been routinely successful.  Research continues, however, and some medications of thermography (such as radiometry) combined with computer analysis of the scans may still achieve the goal of detecting breast cancer as well as expert mammography. Click here for more information.