From sci-fi to reality- microendoscopy to diagnose breast cancer?

The first clinical trial in Europe of a revolutionary approach to diagnosing breast cancer has just got under way at one of the UK’s leading breast cancer centres.

The research involves a minute endoscope, no thicker than a few strands of human hair, which can pass through the nipple and search for the earliest signs of cancer within the breast.

Consultant breast surgeon, Dr Nicolas Beechey-Newman from Guy’s Hospital in London, told a news briefing at the 3rd European Breast Cancer Conference in Barcelona that micro-endoscopy had the potential to detect signs of abnormality in cells lining the breast ducts possibly up to decade before invasive breast cancer develops.

“When we first talked about this technique the response from some quarters was that it was ‘science fiction’. But we’ve proved the doubters wrong. We’ve started to use it on a small number of patients and have already had successes. In one patient who was having a prophylactic mastectomy we found a lesion close to the nipple that would undoubtedly have been missed by the pathologists. It turned out to be a 2 mm invasive cancer. So, for this patient who had made the difficult decision to have a prophylactic mastectomy because of her high breast cancer risk, it confirmed that she would indeed have developed breast cancer in the future.

“I envisage that breast duct endoscopy will be a method of screening high risk patients, such as those who have normal mammograms and clinical examination, but either a genetic abnormality that predisposes them to breast cancer or a very strong family history of the disease,” he said.

Breast endoscopy has been tried before with sporadic reports in medical journals over the last decade, but the endoscopes have been too large. Advances in fibre optics have produced endoscopes less than 1 mm across – ideal in size but with poor picture quality because they contain very few glass fibres. So the Guy’s team, working with endoscope designers and manufacturers Acueity Inc. from California, enlisted ideas from Hollywood film technicians (who use a single glass rod to transmit an image). Then Guy’s developed a dilator and a modified lighting system and the result was a microendscope tailor-made for examining the ducts in the breast.
Once passed through the tiny openings at the tip of the nipple the endoscope sends back magnified pictures of the inside of the breast duct to television screens where doctors can identify any warning signs. Healthy ducts look like blue-white shiny caves with branches leading off. Abnormal areas have lost their shine and have changed to a reddish-pink colour. Surgeons can then plot where the problem areas are before performing a biopsy or carrying out treatment.

“At this stage we are not able to see the whole of the duct in many cases or all of the 10 to 15 main breast duct systems. But, we are continuously improving the technology and we hope in the future to be able to examine the majority of ducts all the way from the nipple to the beginning of the duct deep within the breast. This will be easier once we have the new even finer endoscopes that are being developed.”

At the moment, women at Guy’s undergoing the procedure have a general anaesthetic, but in the future a local anaesthetic may be all that is necessary for many patients.

Dr Beechey-Newman and research fellow Dr Ashutosh Kothari head the first team in Europe to use the microendoscope. But they expect that the endoscope will be used as a diagnostic tool in several European hospitals within the next year or two. A number of US research teams have taken up the technique, principally The Cleveland Clinic in Ohio who began the initial work. The research at Guy’s is partly funded by Cancer Research UK.

“Clearly, the technique does have a long way to go, but our research indicates that we can see pre-malignant changes,” said Dr Beechey-Newman. “This is the most exciting finding because these changes are present for up to 10 years before invasive breast cancer develops. These changes are only infrequently seen by mammography and there is no other imagining system that can show them at all.