NEW YORK, SUNDAY, OCTOBER 27 1996
To insure early diagnosis and treatment, the Breast Cancer Center of New
Jersey in Glen Ridge has acquired a new system to treat breast lesions that are only seen on mammograms. Known as the ABBI system, the stereotactic technology enables a surgeon to identify the targeted tissue within one millimeter of accuracy and remove the entire specimen in one sitting while minimizing the amount of healthy tissue removed from the breast. As a result, patients experience less pain and scarring than they would if they had their suspicious lesions removed by other forms of breast biopsy.
ONE OUT OF NINE AMERICAN WOMEN WILL HAVE BREAST CANCER
"The ABBI system is advantageous for women because it is a one-step process
performed under local anesthesia," said Dr. R. V. Ballem, director of the center, a
free-standing center affiliated with Mountainside, Montclair Community and St. loseph's hospitals. "This means that the patient can go home soon after the procedure and resume her usual activities."
Only a few stitches are required To complete the biopsy, the patient is positioned on the ABBI system table. Her breast is compressed and immobilized so that the suspicious lesion can be better seen and more accurately assessed by the surgeon. Using the stereotactic technology, the surgeon locates the lesion, numbs the area with a local anesthetic and inserts a marking needle into the breast to "tag" the precise location. Using the ABBI biopsy device, the surgeon gently inserts a narrow tube-like device into the breast to remove the entire specimen.
"Another advantage of this system is that the small opening is closed with a few
stitches which also decreases the discomfort of the patient," said Dr. Ballem, who is
also chief of surgery of Montclair Community Hospital in Montclair, New Jersey.
The ABBI system is expected to become a key tool in detecting breast cancer which
affects one out of nine American women. More accurate screening measures are needed because mammography, breast imaging, can't distinguish benign lesions with absolute certainty, and so many women must undergo a surgical biopsy to determine whether the lesion is cancerous. Last year over 700,000 breast biopsies were performed in the U.S. and one quarter of them were found to be she has breast cancerous, according to the American Cancer Society.
We hope that the ABBI system will encourage more women to seek diagnosis and treatment because unlike excisional biopsy, it is a one-step process," said Dr. Ballem.
"Many women didn't like excisional biopsies because they had to go to the x-ray
department first, where a radiologist placed a needle at the site of the lesion so that
the surgeon could find it in the operating room."
Another disadvantage of excisional biopsies was that surgeons sometimes had to remove more breast tissue than necessary because existing technology made it difficult to place the wire marker with a high degree of accuracy, Dr. Ballem said. As a result, many women had large scars. The ABBI system allows the surgeon to remove only a small sample so scars are minimal. Also, excisional biopsies had to be done under a general anesthetic, which left patients feeling groggy afterwards. Because the ABBI procedure is done under a local anesthetic, patients quickly recover after the procedure and feel well enough to resume their usual activities.
The new system also is an improvement over the core needle biopsy, Dr. Ballem said. For an accurate biopsy, the core needle technique requires the surgeon to insert a needle several times to remove a series of small tissue samples. On the other hand, with the ABBI procedure, the surgeon inserts the instrument only once to remove the entire specimen. The ABBI system also reduces the potential for additional surgery because it is more accurate than a core needle biopsy. If a core needle biopsy indicates a malignancy, another operation is needed to remove the remainder of the lesion. With the ABBI procedure, if cancer is found but a margin of tissue surrounding the specimen is "clean," it is up to the clinical judgment of the surgeon to decide whether further surgical intervention is needed. Dr. Ballem urged women to perform breast self-examination each month. Women should have a baseline mammogram at age 40 so that an expert in breast cancer will have a means of comparison to detect later changes in breast tissue. Women between the ages of 40 and 50 should have a mammogram biannually and women over 50 annually.
"Studies have shown that mammograms are effective screening tools because they
reduce by 30 percent the mortality of women over 50 who are found to have breast
cancer," Dr. Ballem said. Women also should pay attention to the early warning signs of breast cancer. These include a lump or thickening in the breast or under the arm, discharge from the nipple, a change in breast size or shape, or a change in the color or feel of the skin or nipple, such as dimpling or puckering.
"About 80 percent of breast biopsies show that the lesion is benign, but women
should be diligent in seeking diagnosis of suspicious lesions because it pays off in fewer deaths and disabilities," said Dr. Ballem.Early diagnosis of breast cancer is crucial because it decreases death and disability. According to the American Cancer Society, 94 percent of women survive breast cancer if it is diagnosed before it has spread to other parts of the body.
