Nola Hylton

Research Interests

Development of Magnetic Resonance Imaging (MRI) techniques for detection, diagnosis and staging of breast cancer.

Research Summary

MRI of the breast, using gadolinium contrast agents, is effective for visualizing breast malignancies. We are investigating the role of MRI as an adjunct procedure to mammography for diagnosing and staging breast disease. Our work includes the use of MRI for characterization of breast disease with application to 1) breast cancer screening in high risk women, 2) tumor staging and pre-surgical planning and 3) monitoring tumor response to pre-operative chemotherapy. We have found that MRI is superior to mammography for showing the amount of disease in the breast, and is particularly valuable for identifying multi-focal breast cancer and ductal-carcinoma in situ (DCIS), which is cancer that has not yet penetrated out of the ducts and is therefore curable. MRI is also effective for following women who receive chemotherapy before their surgery in order to reduce the tumor load in the breast. MRI is a very sensitive and accurate way to monitor tumor reduction and can help identify women early on who are not responding to treatment. We are interested in developing and validating non-invasive imaging markers that can capture tumor changes more accurately than clinical exam and lead to better prediction of outcome. We are also investigating whether MRI can provide an early prediction of response on the basis of tumor changes after only one or two cycles of treatment. More recently we have begun to use MRI for screening and surveillance in women at high risk for developing breast cancer. Women with a heritable susceptibility to breast cancer tend to develop cancer at a young age, when detection by mammography is difficult because of higher breast density. MRI can readily detect small cancers in dense breast tissue. As part of the high risk screening study, we are correlating imaging measurements with immuno-histochemical markers obtained from image-directed biopsy samples. The goal of this project is to better understand the biologic significance of imaging measurements in order to refine imaging methods and improve diagnostic specificity. In particular we would like to improve our ability to differentiate imaging patterns associated with benign disease such as proliferative hyperplasia and fibroadenomas from intraductal and early stage invasive carcinoma. The MRI high risk screening program is a collaboration with the UCSF Cancer Risk Program, with funding from the NIH National Cancer Institute and the University of California Breast Cancer Research Program. An associated area of investigation is the development of quantitative MRI techniques for evaluating new therapeutics in mouse models of breast cancer. Mouse model MRI studies include characterization of tumor response to anti-angiogenic agents and investigation of the mechanism of action of Erb2-targeted drugs using gadolinium-containing liposomes. All of the projects described involve MR data acquisition using contrast-enhanced and diffusion-weighted techniques, image processing and data analysis using statistical methods.

Selected Publications

Hylton NM. Vascularity assessment of breast lesions with gadolinium-enhanced MR imaging. MRI Clinics of North America, 1999; 7:2:411-420.

Esserman LJ, Hylton NM, Yassa L, Frankel S and Weidner N. Utility of MRI in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol, 1999, 17:1:110-119.

Esserman LJ, Hylton NM, George T and Weidner N. Contrast-enhanced magnetic resonance imaging to assess tumor histopathology and angiogenesis in breast cancer. The Breast Journal, 1999; 5:1:13-21.

Esserman L, Kaplan E, Partridge S, Tripathy D, Rugo H, Park J, Hwang S, Kuerer H, Sudilovsky D, Lu Y, Hylton N. MR imaging phenotype is associated with response to AC neoadjuvant chemotherapy in stage III breast cancer. Ann Surg Oncol (in press)

Partridge SC, McKinnon G, Newitt DC, Day MR, Hylton NM. Menstrual Cycle Variation of Apparent Diffusion Coefficients Measured in the Normal Breast Using MRI. JMRI 2001 (in press)