A magnetic resonance spectroscopy (MRS) technique that monitors biochemical changes in tissue could improve the management of women at risk of breast cancer.
Prof Carolyn Mountford, CEO and Director of Research, TRI
|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|
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.
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.
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.
Professor Carolyn Mountford