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New Positron Emission Mammography available at Upstate

Patients with suspicious breast lumps may be able to get more complete answers quickly through a new service called Positron Emission Mammography at Upstate University Hospital.

The new high resolution scanner, which will be dedicated to breast imaging, focuses on the metabolic activity of lesions, which helps to more accurately detect or help confirm the presence of a breast cancer.

"If there is a breast cancer present within the breast, it will show up very quickly," says David Feiglin MD, professor and chair of radiology.

Advanced breast imaging such as Ultrasound and Magnetic Resonance Imaging scans may be able to discern between benign and cancerous lesions. The use of Positron Emission Mammography brings the additional capability of early diagnosis and monitoring to a greater level of accuracy particularly where patients are unable to tolerate MRI procedures or where either ultrasound or MRI are imprecise.

Here's how it works: Patients are injected with flouro-deoxyglucose (FDG), a short lived radioactive fluorinated glucose, that accumulates in all cells that metabolize glucose. Cancer tissues have higher-than-usual metabolic rates, so this compound accumulates to a much higher level than normal tissues, making it easier to discern and visualize abnormal cancerous growths. Patients then undergo breast imaging about an hour after injection in a manner similar to traditional mammography but using positron emission tomography.

The scan reveals active lesions, and, if necessary, it is possible for a radiologist to perform a biopsy immediately to confirm whether the cells are cancerous or to assess effects of any chemotherapy or radiation therapy.

Feiglin says PEM does not replace routine screening mammograms and is not indicated for or reimbursed for screening procedures. It is available for when suspicious lumps or areas appear during routine mammograms. In consultation with the radiology department, doctors can refer patients for PEM instead of asking them to wait three or six months or longer for a second mammogram to see any significant changes  appear.

Medical insurers in Central New York are starting to reimburse for PEM, at present on a case-by-case basis, Feiglin says.