http://www.msnbc.msn.com/id/15990645/
Experimental ultrasound method could mean fewer biopsies for women
CHICAGO - An experimental ultrasound technique that measures how easily
breast lumps compress and bounce back could enable doctors to determine
instantly whether a woman has cancer or not without doing a biopsy.
In a small study of 80 women, the technique — called “elastography” —
distinguished harmless lumps from malignant ones with nearly 100 percent
accuracy.
If the results hold up in a larger study, elastography could save
thousands of women from the waiting, cost, discomfort and anxiety of a
biopsy, in which cells are removed from the breast — sometimes with a
needle, sometimes with a scalpel — and examined under a microscope.
“There’s a lot of anxiety, a lot of stress, a lot of fear involved” with
biopsies, said Susan Brown, manager of health education for the Susan G.
Komen Breast Cancer Foundation. “And there’s the cost of leaving work to
make a second appointment. If this can be done instead of a biopsy,
there would be a real cost reduction.”
Up to 1 million biopsies are performed each year on suspicious breast
tissue detected by mammograms and self-exams, but as many as eight out
of 10 of these biopsies find that the lumps are benign.
Rapid results
Biopsies can cost $200 to $1,000, depending on whether some fluid or an
entire lump is removed, and it can take days or weeks to get the
results. The cost of elastography is not yet clear, but some experts
said the procedure might run $100 to $200. And it can yield results in
minutes.
When checked against biopsies of women’s breast tissue, the ultrasound
technique correctly identified 17 out of 17 cancerous tumors, and 105
out of 106 harmless lesions. The findings were reported at a national
radiology meeting in Chicago this week.
Scientists said the approach may also be used someday to rapidly
diagnose damaged hearts and guide the treatment of prostate cancer.
The technique was pioneered during the 1990s at the University of Texas
Medical School at Houston by Jonathan Ophir and his colleagues.
Ophir describes elastography as a way to measure and picture the
elasticity of body tissue. In effect, it is an extension of one of the
oldest tools in medicine, palpation, in which a doctor feels the shape
and firmness of body tissue.
To explain elastography, Ophir likens the body to a box-spring mattress,
but “a crazy mattress made out of millions of small springs and each one
is a little different. Each is moving around at a different rate,
depending on their individual stiffness.” Cancerous tumors are like
stiff springs. Normal tissue and benign lesions compress more easily.
Both traditional ultrasound and elastography use echoes from
high-frequency sound waves to create pictures of what is going on inside
the body, but elastography goes a step further.
In traditional ultrasound, a doctor or technician places a handheld
device on the skin that sends high-frequency sound waves into the body.
Organs and tissue reflect the sound back as echoes, which are sent to a
computer that turns them into a picture. Many people have seen
ultrasound images of fetuses in the womb.
Echos and movement
Elastography, though, also gauges movement. As the doctor moves the
handheld device against the breast, the device collects echoes before
and after the compression or movement of the breast tissue. The
resulting images show stiff tissues as dark areas and soft tissues as
light areas.
Breast cancer shows up larger on an elastogram than it does on a
traditional ultrasound image, perhaps because the elastogram can “see”
the scar tissue around the cancer, Ophir said.
“It’s like finding a marble in Jell-O,” said Dr. Richard Barr, a
professor of radiology at Northeastern Ohio Universities College of
Medicine who reported his findings at the Radiological Society of North
America annual meeting. Germany-based Siemens AG provided the ultrasound
equipment and software for Barr’s study.
Ophir and other researchers said breast cancer diagnosis will be
elastography’s first real-world application.
“If it doesn’t fly there, it won’t fly anywhere,” said Elisa Konofagou
of Columbia University, who is testing elastography on animals and
humans to determine the extent of damage after a heart attack. Uses in
prostate cancer and
thyroid cancer also are under study elsewhere.
Dr. Constantine Godellas, a cancer surgeon at Rush University Medical
Center, said some patients and doctors would have trouble giving up
biopsies, even if further research confirmed elastography’s accuracy.
Doctors may fear lawsuits if they do not order biopsies, he said.
‘Elastogram’ instantly diagnoses breast cancer 
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