A Needle Biopsy Alternative Riverside to Test Small Camera that Points Out Growths in Breast

The camera at the Riverside Diagnostic and Breast Imaging Center is tiny, compared to older equipment that doctors use to search for cancer. It's about the size of a pint of milk, instead of a 25-inch television.

But doctors hope the little camera can do big things. They want it to find tumors smaller than a dime, or tell a woman that what looked like a problem in her mammogram isn't cancer - without putting her through a biopsy.

Doctors in the Oyster Point office hope to begin patient trials this week on the camera, which was developed at the Thomas Jefferson National Accelerator Facility. Over the next year, they want to run tests on more than 100 women.

Riverside doctors will use the camera as a way to screen patients who come in for a needle biopsy, a less invasive way to take tissue samples. The camera, doctors hope, will show them which women don't really need surgery.

"We're trying to prove that it's sensitive enough for us to rely on without doing a biopsy," said David Wymer, a radiologist at the practice. "We think that it is. But if you miss even one cancerous growth, that's not acceptable."

Despite progress in breast cancer treatment, doctors still don't have a good test to diagnose the disease without taking a tissue sample. Most women who have a biopsy, though, don't have cancer. Of the 1.2 million biopsies done each year in the United States, about 900,000 come back negative.

"Of course that's good for the patients," Wymer said. "Still, they've had to go through something traumatic."

The Jefferson Lab, in partnership with Hampton University, wants to give doctors a clearer picture. The biopsy camera, which is small enough to focus on tiny areas of a breast, is one of several pieces of equipment the lab is developing that use a technique called nuclear imaging.

That allows doctors to pinpoint cancer by tracking a solution containing small amounts of radioactive material. Once doctors inject patients with the solution, cancer absorbs it faster than normal tissue, likely because it's growing more quickly.

At the Riverside diagnostic center, doctors will use the camera along with digital mammography, which is a three-dimensional image of the breast that's displayed on a computer screen. On digital mammograms, potential tumors often show up as white masses.

Doctors will take those images and compare them with pictures from the Jefferson Lab biopsy camera. They want to see if the white masses match up with bright spots that, on the camera's pictures, are evidence of a tumor.

"If it lines up, if it's the same place, it's probably cancer," said Drew Weisenberger, a Jefferson Lab physicist.

The radiation dose needed for the camera to work is low - less than a standard mammogram - and very safe, Wymer said. The radioactive material gives off electromagnetic energy, which the camera converts into electronic signals. That shows up as bright light on a computer screen.

Since tumors gobble up the material, Weisenberger said, they're even brighter than surrounding tissue - so-called hot spots.

If the camera is as accurate as doctors hope, no hot spots would mean no cancer. Patients wouldn't need a biopsy, although doctors would keep monitoring the patient. In addition to saving a patient emotional distress, that would save a lot of money. Biopsies cost anywhere from $1,000 to $5,000, Wymer said, depending on how and where they're done.

Another possibility is that the camera would pick up problems that don't show up in a mammogram, Wymer said.

While doctors are testing the biopsy camera, all patients will continue to get biopsies. Doctors will use biopsy results to help judge the camera's accuracy.

The camera is one of several medical projects underway at Jefferson Lab.

The technology behind it is similar to a camera that the lab is working on with Dilon Technologies Inc., a Newport News company.

The Dilon camera also uses nuclear imaging, but it is larger and can take pictures of an entire breast, said Cynthia Keppel, an HU physics professor and staff scientist at the Jefferson Lab.

While the Dilon camera could replace or supplement standard mammograms, the smaller biopsy camera is meant to focus on tiny areas of the breast once abnormalities show up, Keppel said.

Funding for the biopsy project comes from Jefferson Lab and from a National Science Foundation grant to HU. DuPont Merck Pharmaceutical Company and Fischer Imaging Corp., which builds tables used in needle biopsies, also have provided support.

If all goes well, researchers would look for a company to license the technology and mass-produce the cameras. Conceivably, they could spread across the country within two years, Keppel said.

Doctors are optimistic, especially after tests on plastic-based models.

If all goes well, Wymer said, the camera could become part of a woman's regular diagnostic work-up and also might be helpful for other types of cancer, such as thyroid.

"The real question is, will it work all the time?" he said. "If not, we'll know we need to try something else. If so, we've got something that could make a huge difference."