An interview with Stamatia Destounis
David L. Shenkenberg
Dr. Stamatia Destounis is a radiologist at Elizabeth Wende Breast Care LLC and an associate clinical professor at the University of Rochester, both in Rochester, N.Y. She has worked with technology companies such as Siemens and Hologic Inc. and has earned the Reach to Recovery Award of Excellence from the American Cancer Society.
Since the ACRIN trial in 2003 showed that digital mammography is not only as good, but better, for patients with dense breasts, most facilities have been adopting digital mammography.
You won the Reach to Recovery award in 2001, and you’ve been a strong advocate of women and breast cancer detection technology for a very long time. Looking back, what made you choose this as your specialty?
I did not want to read films in the dark.
I wanted to communicate with patients. When you do diagnose patients with breast cancer, they’re so upset; they’re so anxious. They trust you to tell them what it’s going to be like, and you really do develop a relationship.
You have worked with several companies to develop breast imaging. Any new projects in the works?
I don’t work for any company, but I have over the years worked with companies that do computer-aided detection, like R2, which is now Hologic. I have been doing a project with Siemens Ultrasound called elastography. At Elizabeth Wende, we do digital mammography, so we work with the vendors: Hologic, GE, Siemens.
Why make the switch from film to digital mammography?
I think that most of radiology has gone filmless over the years. Mammography was the last to go because the resolution wasn’t there. Since the ACRIN trial in 2003 showed that digital mammography is not only as good, but better, for patients with dense breasts, most facilities have been adopting digital mammography.
It must have been difficult to make the transition.
It hasn’t been that easy because it’s expensive; it’s time-consuming for the radiologist. It takes two to three times longer. You have to decide who will be administrating the new technology in your office. Let’s say you have a GE workstation and a Hologic workstation – are you going to be reading from the same workstation? The equipment has to be put in one location.
You use MRI, ultrasound and mammography. How do you rate them?
Mammography is our golden standard. So as radiologists, it’s what we count on first. Ultrasound is not considered a screening tool. We do it if we find abnormalities. MRI we do predominantly in patients who have been diagnosed with breast cancer to see the extent of the breast cancer. We do use MRI in patients who have a high risk of breast cancer because of family history or the breast cancer BRCA1 or BRCA2 gene.
I have read in the literature that mammography often detects cancer when cancer is not really there, and these studies say that MRI is better. On the other hand, I have found some studies that say mammography is better than MRI. Would you say that there is a controversy?
There is no perfect test. Mammography works well if you use the criteria very strictly. It’s a reality with either test. There’s going to be a false positive.
Some people predict that MRI could replace mammography. Does that make sense to you?
Not everyone has an MRI in their office or in their clinic. It’s expensive. It’s time- consuming. It takes a lot longer to read. You have to inject the patient with contrast media. In order to have a screening test, it needs to be quick and easy. In MRI, you inject contrast media, so you need intravenous access. Some patients are allergic to the contrast agent. I don’t know that MRI will ever be a screening test.
As you know, insurance company reimbursement is critical for a technology to gain acceptance in health care today. What is the trend here?
They don’t want to spend for MRI. Perhaps for those patients at higher risk, it might be something to consider. They are not willing to pay for ultrasound screening.
Do you think ultrasound will ever be a screening tool?
It may. I think ultrasound is easy to use. There’s no radiation; there’s no injection. Everyone is not an operator. I think we’d have to find ways to standardize the ultrasound examination because everyone does it different ways.
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