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A better biopsy
New diagnostic equipment targets early breast cancer

01/04/18
By Ryan Lessard news@hippopress.com



 The Elliot Breast Health Center is the first facility in the state to offer 3-D-guided breast biopsy procedures, and the first on the Eastern seaboard to have an instant diagnostic system, both of which make the biopsies more accurate and ultimately less invasive.

 
What’s new
New Hampshire has the highest rate of breast cancer in the country based on 2014 data, according to the U.S. Centers for Disease Control and Prevention. But the best way to fight it is early screening and detection. 
Dr. Marina Feldman, the director imaging and co-director of the Breast Health Center, said experts recommend women start to get screened mammograms at the age of 40.
Until fairly recently the equipment used to scan for masses did so using a sort of 2-D X-ray overlay system.
“And the computer would calculate coordinates, almost like 3-D battleship-style,” Feldman said.
But since about 2013, Elliot has been using 3-D scanning technology, known as tomosynthesis, which is tantamount to the difference between X-rays and CT scans. 
The newer system scans multiple one-millimeter layers and puts them together to form a 3-D model, allowing for providers to identify extra-small masses and their locations. But the technology for taking out physical samples for testing had not been as accurate for the better part of the past four years.
“The trouble was the biopsy equipment took a little while to catch up,” Feldman said.
In September, Elliot acquired a couple of new pieces of equipment that have changed the game.
The first is a 3-D-guided prone breast biopsy system. The tomosynthesis screening meant more accurate diagnostics and patients were 40 to 50 percent less likely to be unnecessarily called back for repeat mammograms.
But acquiring a sample from a small mass wasn’t guaranteed. Older biopsy equipment usually would result in misses and sampling larger zones unnecessarily.
“We are now able to sample something that we see on a 1mm slice using the same high-accuracy, high-resolution technology,” Feldman said.
Now, essentially, the scanning and the biopsy equipment are matched, she said.
The way it works is a patient will lay face down on a table, with her breast compressed and fitted through a hole in the table. Using the 3-D scanning as a targeting guide, it can sample a mass as small as 1 or 2 millimeters in diameter, which is essentially a “speck,” Feldman said.
This reduces procedure time and reduces the amount of X-rays patients are exposed to.
A second piece of equipment that works in tandem with this is the Brevera breast biopsy technology, made by the same manufacturer, Hologic. 
The Brevera sucks a biopsy sample down a tube and directly into a specialized X-ray device that can scan the sample to make sure it has microcalcifications, which are a manifestation of early breast cancer roughly the size of chalk dust, and display the image within a matter of seconds.
Before, samples had to be removed from a capsule and scanned manually in a dedicated device. Those added steps made the process longer and providers would take multiple samples before testing them to be sure they caught what they saw in the scans. 
Now, Feldman said, they can stop sampling as soon as the display confirms the biopsy was successful.
Feldman said the device just recently received FDA approval and Elliot Breast Health Center is the first on the East Coast to install one. 





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