The suburb of Villejuif in the south of Paris will never rival the Eiffel Tower or the Louvre as a destination site. Yet every day the brightly lit waiting rooms and cavernous hallways of the Gustave Roussy hospital located here fill with hundreds of visitors, some of them traveling thousand of miles in pursuit of hope.
Since it opened 70 years ago, Institut Gustave Roussy has grown into Europe’s top cancer center and one of the leading cancer hospitals in the world. The 3,000 doctors and staff working here include specialists in dealing with rare and complex tumors. Others, like radiologist Dr. Corinne Balleyguier, are developing new fast ways to diagnose and treat cancer. “Sometimes there are images that are hard to read, and these women do not know whether they have cancer or not,” she said during a recent visit. “The uncertainty can be nerve-wracking and want to reduce it as much as possible.”
Balleyguier says that in the past many women had to wait as long as two months for a result. “This is too long,” she said. “The clock is ticking, and we have to move as quickly as possible and start treatment early.” That’s why she and her colleagues designed the One Stop Clinic — a daylong diagnostic series that enables most women with abnormal mammography findings and possible breast cancer lesions to arrive in the morning and leave with a result and a treatment plan in the evening.
The idea for the One Stop Clinic goes back to 2004, when Balleyguier and Dr. Suzette Delaloge, associate professor of medical oncology and head of the breast cancer department at Gustave Roussy, started looking for ways to speed up diagnosis. At that time, almost 50,000 women were being diagnosed with breast cancer every year in France alone. “We started seeing younger patients with dense breasts and more complex lesions,” Balleyguier said. “We wanted to develop a multidisciplinary approach that would deliver high-quality care and reduce the time between screenings primary evaluation deemed positive and diagnosis.” Delaloge says that at the time, nothing like that existed, “or at least not on a scale as large as we were planning.”
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GE’s SenoClaire is a low-dose, 3D X-ray system that allows doctors to image the breast in 1 millimeter slices, inspect each, and potentially reduce the amount of false positives. It uses the same amount of radiation like a traditional 2D mammogram. GIF credit: GE Healthcare
The women — usually between 20 and 30 of them — start arriving around 8 a.m. and file into a bright waiting room. A coordinating nurse divides them into three groups based on the findings in their referrals and schedules them to see three different specialists for examination and screening in imaging machines that include GE’s latest digital mammography system.
The most serious cases go straight to an oncologist who can outline a treatment plan. Women with suspicious lesions smaller than 10 millimeters first visit a surgeon who typically carries out a series of tests. The final group visits a radiologist for a consultation.
The doctors may order tomosynthesis — a procedure where a digital mammography machine takes multiple images of the breast and combines them into a 3D picture; ultrasound-guided biopsy that may involve fine needle aspiration (FNA) — when doctors remove cells or fluid from a lesion or lump using a needle similar to a blood-sample needle; and a procedure called contrast-enhanced spectral mammography (CESM), which uses an intravenous contrast fluid to highlight blood-flow patterns streaming into energy-hungry cancerous areas. “It’s very important to have everything in place,” Balleyguier said. “We can provide immediate feedback to the doctors and carry out new exams.”
Jean-Baptiste Brunet, who has been working at Gustave Roussy for five years, is one of technicians who carry out the imaging on Mondays. Brunet has been working with GE engineers to develop the latest mammography platform and now operates the machine. “It’s a long day,” he says. “We tried to make the experience as pleasant as possible.”
The hospital painted the room that houses the system a warm fuchsia, and music plays in the background. The machine itself has an easily accessible carbon-fiber breast examination tray devoid of sharp angles. It enables women to go through the six-minute screening without tensing their muscles, which could affect image quality. “We know that if one woman has had a bad experience with mammography, she will communicate that to her peers,” says Aurelie Boudier, global creative director for brand and design language at GE Healthcare’s Global Design Centre in Buc, near Paris. “The reverse is also true. If a woman has a positive experience, and her fears are addressed and the procedure is made as agreeable as possible, she will spread a positive message among her peers and come back for future screenings.”
Brunet says the patients he sees usually come with a mammography or an ultrasound finding. “The doctor tells us she sees something in a part of the breast, and we typically use CESM to complete the diagnosis. If we find something, then the patient goes straight to biopsy.”
At the end of the day, the doctors invite the patients for a final consultation to discuss the diagnosis and plan their treatment. “The results are remarkable and truly unlike anything we’ve seen happening anywhere else in the world,” says Gustave Roussy’s Delaloge.
Since 2004, the One Stop Clinic has seen more than 11,000 patients, and more than 75 percent of them have received a diagnosis on the same day, according to an independent study. Says Delaloge: The majority of patients who come to our facility don’t have to worry about false positives or callbacks which, as you know, are an issue in breast cancer diagnostics.”