Sunnybrook researchers are using imaging technologies and imaging combined with novel agents to improve breast cancer detection and diagnosis, better define aggressive disease, enhance treatment and track treatment responses faster for more tailored treatment.

Dr. Martin Yaffe, senior scientist, SRI and Dr. Roberta Jong, Sunnybrook breast-dedicated radiologist are using digital tomosynthesis, a newer imaging technology, to enhance detection and diagnosis. Instead of two views with digital mammography, tomosynthesis takes up to 15 low-dose images of the breast. The resulting three-dimensional composite improves view of abnormalities and potentially reduces false findings.

Dr. Ellen Warner, medical oncologist, Odette Breast team and SRI scientist, and Dr. Anne Martel, senior scientist, SRI, are using MRI to enhance detection and diagnosis for women at high risk. Studies led by Dr. Warner show MRI detects at an earlier stage, more than twice as many breast cancers as mammography, ultrasound or clinical breast examination. Dr. Martel is collaborating with radiologists to develop computer-aided diagnosis and detection techniques and patient motion ‘correction‘ tools for better imaging quality and accuracy.

DCIS (ductal carcinoma in situ) is a non-invasive form of breast cancer in about 20 per cent of diagnoses. While highly curable, some women will develop invasive disease. Dr. Eileen Rakovitch, head, Odette Breast team, Dr. Yaffe and Dr. Belinda Curpen, acting head, Breast Imaging are using imaging to look at recurrence risk after treatment in women with dense breasts with DCIS. Dr. Peter Burns, senior scientist, SRI, and Dr. Yaffe and Dr. Jong are using new ultrasound imaging techniques: microbubble contrast and tissue elastography, to differentiate DCIS from invasive disease. Microbubbles pass harmlessly through the circulation allowing ultrasound to detect microscopic blood vessels, the early development of which may be a danger sign in DCIS. Elastography creates wobbles in tissue which enables ultrasound imaging of very subtle changes as growing tumours make tissue harder.

Locally Advanced Breast Cancer accounts for 15 per cent of diagnoses and often involves chemotherapy and or radiation to shrink large tumours before surgery. Dr. Gregory Czarnota, scientist, SRI and radiation oncologist, Odette Breast team is using ultrasound-activated microbubbles to sensitize tumours to lower doses of radiation in these patients. Dr. Jean-Philippe Pignol, radiation oncologist, Odette Breast team and scientist, SRI is using gold nanoparticles loaded into tumour cells. When exposed to a novel type of x-ray, these particles produce highly damaging Auger electrons.

Faster tracking of tumour response facilitates tailored treatment and reduces toxicity. Dr. Czarnota, and Dr. Greg Stanisz, senior scientist, SRI are using ultrasound and MRI to show tumour metabolic response to chemotherapy. Clinical trials with ultrasound show tumour response as early as one week into chemotherapy, compared to PET and CT that typically take several months.