“Biopsy guided by a fusion of magnetic resonance imaging (MRI) and ultrasound (US) improves detection of aggressive prostate cancer compared with mapping or targeting alone and systematic 12-core biopsy.
“Among the first 1,000 men to undergo MRI-fusion biopsy of the prostate at the University of California Los Angeles (UCLA), the presence of a grade 5 region of interest on fusion biopsy was the strongest predictor of high-grade prostate cancer. ‘Patients who had a grade 5 lesion compared to those who had no suspicious lesions had 23 times the odds of having Gleason ≥7 cancer,’ said Christopher Filson, MD, at UCLA.
“In a separate series of men presenting for prostate biopsy at New York University (NYU), MRI-targeted biopsy increased the detection of Gleason ≥7 prostate cancer by 23% compared with systematic biopsy while decreasing the detection of Gleason 6 disease by 26%.
“Around 90 per cent of all breast cancers can be definitively diagnosed using magnetic resonance imaging (MRI). This compares to the combined methods of mammography and ultrasound which yielded a detection rate of just 37.5 per cent. This is the key finding of a study published in the highly respected Journal of Clinical Oncology. The study was carried out at the University Department of Radiology and Nuclear Medicine at the MedUni Vienna in cooperation with the University Department of Gynaecology and Obstetrics and the Clinical Institute of Pathology.
” ‘In cases where there is even the slightest doubt, and especially in women at increased risk, the obvious choice is MRI. Our study clearly shows the superiority of magnetic resonance imaging over mammography and breast ultrasound examinations,’ says Thomas Helbich, who led the study with Christopher Riedl. “The superiority of MRI is also completely independent of the patient’s age, gene mutation status and breast density.”
“In 559 women at increased risk, a total of 1,365 screening examinations were carried out. There was one clear ‘winner’: 90 per cent of all breast cancers can be clearly detected by MRI. The combination of MRI and mammography increased the detection rate by just five per cent. None of the cancers were detected by ultrasound alone. The results were similar for non-invasive cancers and for benign breast lesions.”
“Initial results from the Göteborg randomised screening trial indicates that using MRI (Magnetic Resonance Imaging) alongside conventional prostate cancer screening seems to offer improved cancer detection and can help avoid unnecessary biopsies.
“Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths). Screening for prostate cancer is a controversial issue, with until recently, little clear evidence that existing screening procedures, using PSA (to be followed by biopsies), were effective. In general, either the screening has tended to miss many cancers, or to give false positives, meaning that many men are subject to invasive testing and perhaps treatment which was just not necessary.
“The Göteborg Trial is the Swedish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which is the largest randomized prostate cancer screening trial in the world. In 2014 results from this trial showed a significant mortality reduction with prostate-specific antigen (PSA) screening for men aged 55-69 years of age. Now new work, presented at the European Association of Urology Conference in Madrid, shows that using MRI may further improve the accuracy of prostate cancer screening. This research has been awarded the EAU’s First Prize for the Best Abstract by a Resident.”
“In a single-center study reported in the Journal of Clinical Oncology, Riedl et al found that screening with magnetic resonance imaging (MRI) had greater sensitivity for detection of breast cancer in high-risk women vs mammography or ultrasound irrespective of age, mutation status, or breast density. The addition of mammography or ultrasound added little to the sensitivity of MRI.
“In the study, BRCA mutation carriers and women with a high familial risk (> 20% lifetime risk) for breast cancer were offered screening with mammography, ultrasound, and MRI every 12 months at the Medical University of Vienna. Overall, 559 women with 1,365 complete imaging rounds were included in the analyses. There were 204 suspicious findings (15%). Of these, 38 (19%) were malignant; two additional cancers were found during the study period, including one identified by patient-requested biopsy and one interval cancer…
“The investigators concluded: ‘MRI allows early detection of familial breast cancer regardless of patient age, breast density, or risk status. The added value of mammography is limited, and there is no added value of ultrasound in women undergoing MRI for screening.’ ”
“Cancer screening of women with dense breast tissue is a subject of great interest to both the medical community and the press. Dense parenchyma reduces the sensitivity of mammography to half that of fatty breasts. Approximately 40% of women 40 years of age or older have dense breast tissue, making supplemental breast cancer screening essential.
“Although supplemental screening via ultrasound is unaffected by breast density, is not associated with ionizing radiation, and does not require IV contrast material, acceptance of this modality has lagged.
“According to Ellen B. Mendelson, professor of radiology at Northwestern University Feinberg School of Medicine, and Wendie A. Berg, professor of radiology at Magee-Womens Hospital of UPMC, a significant factor is lack of available intensive training opportunities.
” ‘The most common alternative screening modality, MRI, cannot be used with women who have pacemakers or other devices, severe claustrophobia, or renal insufficiency,’ say Drs. Mendelson and Berg. To realize ultrasound’s potential to increase the number of cancers detected, intensive training programs need to be put in place for physician performers and interpreters for both handheld and automated breast ultrasound systems.’ “
“If results of a prostate-specific antigen test or digital rectal exam are positive, the next port of call is normally a prostate biopsy to confirm whether cancer is present. In a new study published in JAMA, researchers claim a targeted biopsy method is much more accurate in detecting high-risk prostate cancers than the standard biopsy technique.
“The standard method of prostate biopsy, also referred to as a core needle biopsy, involves a doctor removing samples of tissue from the prostate using a thin, hollow needle. The samples are then sent to a pathologist who views them under a microscope and assesses them for cell abnormalities that indicate cancer.
“But the research team, led by Dr. Mohammad Minhaj Siddiqui of the University of Maryland School of Medicine – who was a fellow at the National Institutes of Health at the time of study – says the technique used in their study involves a combination of ultrasound and magnetic resonance imaging (MRI), which they say can effectively differentiate high-risk prostate cancers from those that are low risk.
” ‘There is a concern that we overdiagnose and overtreat low-risk cancers that are unlikely to be terminal, and this technology enables us to make a more reliable diagnosis than the current standard practice,’ says Dr. Siddiqui.”
“The addition of MRI to mammography significantly improved screening sensitivity among women who harbored BRCA1 or BRCA2 mutations, according to study results.
“The sensitivity of the screening combination also was comparable among women aged older than 50 years and those aged younger than 50 years, results showed.
“Xuan-Anh Phi, PhD, of University Medical Center Groningen in the Netherlands, and colleagues pooled individual patient data from six screening trials of high-risk individuals.
“The trials comprised a combined 1,951 women with BRCA1/2 mutations. The median age of the entire population was 41 years; 16.9% were aged 50 to 59 years and 5.5% were aged 60 years or older.
“Of the breast cancers detected, 141 occurred in women aged younger than 50 years, and 43 occurred in women aged 50 years or older.
“MRI detected 78.8% of the cancers, and mammography detected 38.6%. The combination of MRI and mammography detected 88.6% of the cancers and was associated with a significant improvement in screening sensitivity compared with mammography alone (93.4% vs. 39.6%; P˂.001). However, the combination of both screening methods was associated with a reduced specificity compared with mammography alone (80.3% vs. 93.6%; P=.0016).”
In 2007, Steven Keating got his brain scanned for fun. “I volunteered for a study,” says Steven, who was then a student at Queen’s University in Canada. “I wanted to help science, and I was curious about seeing my brain.”
He saw more than anticipated—the magnetic resonance imaging (MRI) revealed a dime-sized abnormality in his left frontal lobe. But the researchers couldn’t tell what it was, and he had no adverse symptoms. “They said ‘don’t worry, keep an eye on it,'” Steven, who is now a Mechanical Engineering graduate student at the Massachusetts Institute of Technology (MIT) Media Lab, recalls. A follow-up scan in 2010 wasn’t worrisome either. Continue reading…
“The latest advancement in prostate cancer detection is magnetic resonance imaging and ultrasound fusion-guided biopsy, which offers benefits for both patient and physician.
“The only place in the Southeast offering the MRI-US image fusion technique is at the University of Alabama at Birmingham Program for Personalized Prostate Cancer Care.
“It is estimated that 2014 will see more than 240,000 new cases of prostate cancer, and more than 29,000 deaths from the disease, according to the National Cancer Institute.
“Jeffrey Nix, M.D., along with colleague Soroush Rais-Bahrami, M.D., both assistant professors in the UAB Department of Urology, studied the MRI-US image fusion as fellows at the NCI. Nix and Rais-Bahrami are two of a select few urologists in the United States trained to utilize this technology; together they have five years’ experience using this approach.
“Nix and Rais-Bahrami say this new technology offers a ttargeted biopsy,’ which refers to direct tissue sampling of suspicious areas seen on MRI as opposed to the traditional method of random, systematic sampling that is essentially performed ‘blindly’ in different ‘ZIP code’ regions of the prostate.”