MR Spectroscopy FOR women at high risk of breast cancer 

A magnetic resonance spectroscopy (MRS) technique that monitors biochemical changes in tissue could improve the management of women at risk of breast cancer.

---

Head Researcher	Prof Carolyn Mountford, CEO and Director of Research, TRI A/Professor Peter Malycha, Clinical Director, TRI
Team Members	Dr Scott Quadrelli, Clinical Research manager, TRI Ms Jessica Buck TRI/ Oxford Dr Sue Jeavons, Director of  Radiology, PAH A/Professor Gorane Santamaria, Radiologist, TRI and Hospital Clínic de Barcelona, Barcelona, Spain A/Professor Ian Bennett, Chairman Breast and Endocrine Surgical Unit , PAH, BreastScreen QLD, Surg Director North Brisbane Family History Clinic A/Professor Chris Pyke, Breast and Endocrine Unit, The  Mater Hospital A/Professor David Clark, Director, Breast and Endocrine Centre, Gateshead NSW A/Professor Robert Parkyn, Surgeon The Adelaide Breast Clinic Dr Melissa Bochner, Surgeon, The Adelaide Breast Clinic Dr David Walters, Surgeon, The Adelaide Breast Clinic Mr Jameen Arm, Radiographer, Hunter New England Health Ms Judith Silcock, Data Manager Breast and Endocrine Centre, Gateshead NSW Dr Michele Roy, Radiologist, Hunter New England Health   Dr Kin Men Leong, Radiologist Hunter New England Health Dr Peter Lau Radiologist, Hunter New England Health Dr Randell Brown, Radiologist, Jones and Partners, Adelaide Dr Michelle Reintals, Radiologist, Jones and Partners, Adelaide
Body Part	Breast
Equipment Used	Siemens Magnetom Primsa or Skyra 3T MRI
Process Used	2-D localized correlated spectroscopy (L_COSY) protocol
Research Areas	Diagnostic imaging and spectroscopy
Disease	At risk women for Cancer
Tags	Breast, surgery, Cancer, breast cancer, genes, genomics, imaging, technology, Siemens Healthcare, radiology
Commercial Partnerships	Siemens Healthcare
Institutions	Translational Research Institute, Princess Alexandra Hospital, The Mater Hospital, Hunter New England Health, Gateshead Breast and Endocrine Centre,  St Andrews Hospital Adelaide, The Adelaide Breast Centre

About the Project

Professor Carolyn Mountford’s multidisciplinary team has been working to develop a new magnetic resonance spectroscopy (MRS) technique that can provide information on changes to human breast tissues that are not seen by current imaging modalities. The clinical objective is to provide women at high risk for breast cancer with an objective means of telling when their breasts are no longer normal but before a cancer is present. This would reduce or delay the need for preventive mastectomies among women at high risk including those who carry the BRCA gene mutations.

Mutations with BRCA1 and BRCA2 bring around a 50 per cent risk of developing breast cancer before the age of 50 and many such carriers currently opt to have mastectomies to avoid getting cancer later in life. Similarly women with a significant family history of breast cancer but who do not carry a known gene (this is a more common clinical problem) face major dilemmas regarding treatment options.

Using a technique known as localised correlated spectroscopy (L-COSY) they identified chemical disparities likely to be associated with the pre-invasive cancer state – a very early stage of disease development.

These changes appear to represent a series of early warning signs that may allow women to make informed decisions as to when, or if, they have a prophylactic mastectomy.

It took a multidisciplinary team including MR physicists, chemists, surgeons, radiographers and radiologists to carry out this work over many years. The L-COSY protocol was used on a pilot group of women carrying BRCA mutations and compared with healthy controls. L COSY identified statistically significant biochemical changes in women with BRCA1 and BRCA2 gene mutations compared with  the controls. It is important to note that conventional investigations including mammography, breast ultrasound and contrast-enhanced breast MR imaging did not reveal an abnormality in any of these women.

Dr David Clark, from the Breast and Endocrine Centre in Gateshead (NSW) was interviewed at the time this was published and indicated he believed a protocol could be developed using MRI and L COSY to help guide treatment decisions and bring added reassurance for BRCA-positive women. He indicated there appeared to be three stages of pre-cancer progression in their breast tissue.  Women at stage 1 may be able to have their breasts monitored with MRI and L COSY every six months. Those at stage 3 may be at greater risk and could consider early surgery.

In considering the breast cancer risk for BRCA gene carriers it is very important to note that half will never develop breast cancer. L COSY may be able to  identify the fifty percent who do not need surgery.

A recent L COSY study of non gene carrier high risk patients has identified  a subgroup that may be at much greater risk of cancer and who cannot be identified by current clinical algorithms.

The next phase of the project is to move from the pilot phase into the clinic. Patients will be recruited in Queensland by A/Professor Ian Bennett and his colleagues at the high risk clinic in North Brisbane and at PAH. Similarly, A/Professor Chris Pyke and his team will recruit patients from the Mater clinics. Patients will continue to be recruited from Newcastle and Adelaide.

The technology

L COSY is a non-invasive scanning technology using a state-of-the-art Siemens Magnetom Prisma or Skyra 3T scanner and breast coil.   Professor Mountford’s team has been a worldwide development site for Siemens in magnetic resonance spectroscopy since 1999.  Siemens has long held the belief that technology cannot reach its full potential in the factory.  To truly advance human health, Siemens believes it has to partner with people like Professor Mountford and her team. 

The aim now is to expand the trial and continue to monitor women in the original study group to learn more about the biochemical changes and what they represent.

Translational Research - Milestone T3

This research fits into the translational pathway at T3. The basic science has been done, a commercial partner has been identified and a clinical evaluation by a multidisciplinary team is about to start.

> For information about clinical trials and commercial partnerships please contact [email protected]