Mass General Hospital Department of Radiology - Breast Imaging

The Breast Imaging Division Of The Massachusetts General Hospital

Major advances have been made, over the past twenty years, in the detection and diagnosis of breast cancer. For the first time in 50 years the death rate has begun to diminish from breast cancer and much of the decrease is likely due to screening and earlier detection. The Breast Imaging Division in the Department of Radiology at the Massachusetts General Hospital has been at the forefront of those developments both in research and in the delivery of high quality care. The Division is internationally recognized as one of the leading groups in the field of breast cancer detection and diagnosis. The Breast Imaging Division has developed many of the approaches to the early detection of breast cancer that are used nationwide.

The MGH Breast Imaging Division was among the first to recognize the importance of having a radiologist who is expert in breast evaluation supervise and interpret all imaging tests that involve breast evaluation (mammography, ultrasound, computed tomography, etc.). Ours was the first "Breast Imaging" Division in the Country.

The Breast Imaging Division is responsible for numerous innovations in breast cancer detection and diagnosis. A major innovation was the development of a needle/wire guide and system for positioning the guide that facilitated extremely accurate guidance for surgeons to permit the removal of small lesions that were visible by mammography, but that the surgeon could not feel. The adoption of this system in the U.S. and other countries made it possible to aggressively pursue small lesions and detect small cancers with a minimum of surgical trauma.

The Division has always been conscious of "operations improvement" (even prior to the recent Institutional effort) and developed a computerized mammography reporting system that eliminated the need for a transcriptionist, streamlined the interpretation of screening mammograms, and made MGH immediately compliant with the emerging requirements of the Mammography Quality Standards Act. The system was developed without any support from the Institution while saving the Institution $35-50,000 every year.

The MGH approach to mammographic interpretation and reporting is the basis of the Breast Imaging Reporting and Data System developed by the American College of Radiology under Dr. Kopans’ leadership. Part of this is now required by the Food and Drug Administration for all mammography reports.

The Division has pioneered the use of "double reading" demonstrating the ability to improve the detection rate of breast cancer in a very efficient system that can reduce the cost of screening while providing the extra benefit of having more than one expert in mammography review every mammogram. The MGH is one of the only groups in the region that provides "double reading" for all screening mammograms. This significantly increases the detection rate of breast cancer.

Division research established the appropriate use of ultrasound in the evaluation of the breast. Methods to better position the breast in mammography units, and compress the breast for optimized mammographic imaging have resulted in several patents.

In addition to the high quality of the clinical activities in the Division, major research projects are being undertaken to improve the ability to detect and diagnose breast cancers earlier, and more completely.

The MGH Breast Imaging Division conducted much of the basic clinical research in digital mammography. One of the first full field digital detectors in the country was evaluated by the Breast Imaging Division and the results of that evaluation along with Dr. Kopans’ intercession were instrumental in the FDA approval for full field digital mammography.

The Division has shown that digital mammograms can be sent electronically anywhere in the world. We are interested in developing methods to use this capability to provide high quality screening services (telemammography) to underserved regions of the country. We have already demonstrated that digital mammograms can be transmitted in approximately 3.5 minutes using satellites. This ahs been done more than 90,000 times without an error.

The first use of digital tomosynthesis in the breast has been conducted by the MGH Breast Imaging Division with very exciting results. This has already resulted in the creation of a unique algorithm that does not require detector movement. Based on a Department of Defense grant, General Electric built a tomosynthesis device as specified by the MGH that is the first of its kind in the world that can be used to evaluate the entire breast using three dimensional mammography. This will permit detection of some cancers that are presently overlooked and reduce the need to call back many women who have equivocal mammograms.

The Division is also exploring other uses of digital mammography to aid in the detection and diagnosis of breast cancer.

Research to evaluate, and define the uses of magnetic resonance imaging is being conducted. Our research was the first to show that MRI can find early breast cancers in breasts that are normal on clinical examination and mammography. The ultimate goal of the research is to develop techniques to find early cancer in women in whom mammography is less effective.

Research in the use of positron emission tomography and other nuclear medicine techniques in breast evaluation have been, and continue to be conducted in the Breast Imaging Division. Our results and experience have helped define the role of these tracers in breast evaluation.

The Division has helped to develop a large library of digitized images which are important elements in developing computer routines to aid in detecting breast cancers.

The Division is working with groups from the Department of Defense and the Intelligence community to try to adapt systems developed for war into methods of detecting cancers earlier to save lives. Preliminary, innovative work on the elastic properties of normal and diseased tissues is taking advantage of work done, initially for the intelligence community.

Dr. Daniel Kopans has directed the Division since 1978. He is an internationally recognized expert in breast cancer detection and diagnosis and the senior expert in the Institution in this area. In addition to having written the primary textbook in the field of breast imaging, Dr. Kopans has written over 160, scientific articles, published in peer reviewed journals on breast cancer detection and diagnosis. He has participated on and chaired numerous committees in the field and has lectured extensively in the United States and abroad. He conducts numerous courses and seminars to train and provide continuing education for medical students, residents, technologists, and practicing physicians.

Major advances have been made in patient care through improvements in medical imaging. The Breast Imaging Division has been at the leading edge of these developments and has a very active research and development program to improve our ability to detect and diagnose early breast cancer. The reason that the survival of breast cancer patients at the MGH has improved dramatically over recent years is due, in large part, to the efforts of the Breast Imaging Division and the earlier detection of breast cancer.