Health Team

3-D Imaging Can Make Breast Cancer Treatment More Effective

Posted April 4, 2007
Updated May 11, 2007

Mammograms and ultrasound are on the frontline of early breast cancer detection, but a recent study shows Magnetic Resonance Imaging (MRI) should play a stronger role. Newer MRI tools can reveal tumors missed by standard screening methods.

In the fall of 2005, Marlyn Smith had what she thought was an infected bug bite on her right breast. She played it safe and had it checked.

"We did a mammogram, ultrasound and they both came back negative," Smith said.

Still, the condition grew worse. Smith had inflammatory breast cancer, a rare but aggressive form of the dieases often missed by standard screening methods. She did not know it was cancer until three months later when she came to Wake Radiology for an MRI.

"It was overwhelming. When I first saw it, it showed all the cancer," Smith said.

Dr. Glenn Coates said an MRI is too expensive to replace mammograms and ultrasound and he said they are still effective tools for early detection, but a recent study in the New England Journal of Medicine shows that for women who have a positive needle biopsy, more detailed imaging is needed.

"Those patients should all have an MRI before therapy and the treatment is designed," Coates said.

In about 1 out of 10 cases where standard screening diagnosed cancer in one breast, MRI found early stage cancer in the other. The MRI equipment at Wake Radiology has other advantages. They're one of the few centers in the state able to look at the breast scans in three dimensions.

"As you can see, I can grab the 3D model and turn it around in space," said Dr. Coates, as he used the computer screen cursor guided by a desk top mouse.

From the flat two-dimensional view, one tumor measured two centimeters. However, that measurement is true only from one perspective. A three-dimensional image showed another view.

"The tumor is actually 5-1/2 centimeters in size," Coates said.

The 3-D view also reveals several satellite tumors hidden in the previous 2-D image. Coates said radiologists can correctly interpret a tumor's true size through two dimensional images, as they move through the different "slices" of images provided by MRI.

However, Coates said the ability to enhance the image in a 3-D perspective is useful to both the patient in understanding their disease and to the surgeon who can use the information to better plan the surgery.

A better understanding of the staging of the disease also helps determine treatment.

"So this patient is better served by mastectomy than lumpectomy," Coates said.  referring to the same 5 and a half centimeter tumor.

Marlyn Smith had surgery to remove the breast and several lymph nodes. She had radiation and is near the end of her schedule of chemotherapy treatments. She said when the symptoms first appeared, she knew something was wrong, even though the early tests were negative. Other women, she said, should trust their instincts and get a second or third opinion.

"And then ask for the tests that are available. Why not? It could save you your life," said Smith.

Most insurance providers will cover MRI costs if there is a positive needle biopsy. Most will also cover an MRI test, even if standard screening is negative, but the symptoms concern the patient and their doctor.


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  • GJXman Apr 12, 2007

    It's great to see how passionate Dr. Coates is in dicussing Breast MRI. His presentation "Breast MRI: From the Patient Perspective" is a great tool in understanding Breast Cancer and how MR's play a vital role. Gd to answer your question. He is using an MR CAD system called DynaCAD manufactored by Invivo. More info on the product at

  • Roach Apr 10, 2007

    She said when the symptoms first appeared, she knew something was wrong, even though the early tests were negative. Other women, she said, should trust their instincts and get a second or third opinion. "And then ask for the tests that are available. Why not? It could save you your life," said Smith.

    Good for her. I am glad to read that she took an active role in pressing forward regarding her health. Unforunately, a lot of people just blindly trust the Doctors instead of listening to their bodies. I am sure it has cost many unknown people their lives. Doctors are human, and prone to error also. They make the best educated guess with all of the facts they have before them.
    My sister also had breast cancer and she has been cancer free for over 10 years now. I hope that will serve as a form of encouragement to those of you who have had it.
    I am sorry to read about your great loss bluebird and newsjunkie. Hopefully one day soon there will be a cure for this terrible disease.

  • ladyblue Apr 8, 2007

    I am truly sorry for the lost of lives from this disease. I underwent radical masectomy in 05 and have fluid buildup problems. If I'd had this opportunity I may have been able to avoid the radical with all it's painful effects when the fluid builds. Without lymp nodes fluid doesn't flow through body but builds up in some cases.My insurance allows one diagnostic mamogram yearly now and I hope that's good enough. Don't want to go through it again.

  • packandcanesfan Apr 5, 2007

    Anything that could provide a clearer picture of the breasts should be paid for by the insurance companies. BCBS (regular State Health Plan)will not pay for a mammogram AND yearly exam. You have to choose either or. In the meantime, if you can't afford to pay one out of pocket, things happen. Mammograms are painful. They should be eliminated and these scans should be the way to go.

    Sorry for the loss of loved ones/friends for some of the posters here. I lost an aunt to it and a very good friend of mine is a survivor.

  • gd Apr 5, 2007

    I would like to learn more about the technology in this news report. Can anyone help me find the 3D viewing systems manufacturer name?

  • Newsjunkie Apr 5, 2007

    The article says most insurance companies will pay for the MRI if there is a positive needle biopsy. Wouldn't it be better to have the MRI BEFORE doing the needle biopsy? My mother died of liver cancer 9 years after having a mastectomy which also removed several lymph glands which left her with an enlarged arm that she had to "compress" each day to get the fluids out of her arm. I have also two friends who have had breast cancer in the past 5 years (keeping our fingers crossed). I presently get the newer digital mamogram which I hope is becoming the standard.

  • bluebird1075 Apr 4, 2007

    I lost a sister in Sept. 06 to this dreadful disease. I have to wonder if this had been available to her when she was first diagnosed in Feb. 03 if she would still be with us today. I would hope that any insurance company would be willing to pay for this additional testing if only for the peace of mind of the patient. Once someone is diagnosed with breast cancer all they have left is HOPE. Hope that everything that is possible will be done to save their life no matter what the cost.