SenoBright Customer Presentation USA version

GE CESM machine

1. SenoBright TM Contrast-Enhanced Spectral Mammography Get a confident diagnosis for your patients faster TM Trademark of General Electric

2. Mammography is a reliable tool, but has limitations Dense breast tissue can overlap with lesions Lesions are not always visible with x-ray Interpretation of images can vary among radiologists Source: Kolb et al. Radiology 2002; 225:165-175 Dromain C., et al, Breast Cancer Research, 2012; 14(3): R94

3. Complementary techniques are therefore required Limited availability of other exams can increase time to diagnosis Delays can increase patient anxiety Other imaging modalities such as Breast MRI can be cost-prohibitive, take a long time to access, and require long exam times, or have highly operator dependent results 3 Source : Dromain C., et al, Breast Cancer Research, 2012; 14(3): R94

4. Get a confident diagnosis for your patients faster Enhance your Breast Care pathway with SenoBright Increase your diagnostic confidence Localize known or suspicious lesions with iodine contrast Improve your patients’ experience Reduce patients’ anxiety by solving the case at the same time, same location and with the same equipment Reduce your diagnostic costs Benefit from an affordable complementary exam that reduces unnecessary exams & frees-up time on your other imaging systems. Mammography SenoBright Contrast Enhanced Spectral Mammography (CESM) is used as an adjunct following mammography and/or ultrasound exams to help localize a known or suspected lesion.

5. How does SenoBright work ? Contrast agent highlights areas of unusual blood flow SenoBright uses multiple x-ray exposures to reduce background signal, effectively highlighting contrast enhanced areas Two images per view are provided: Low Energy image uses standard mammographic techniques and represents tissue density The Recombined image is a contrast-enhanced image in exactly the same position 5

6. How to easily implement SenoBright in your clinical routine? 6 Less than 7 minutes exam after inconclusive mammography & ultrasound S tandard intravenous iodine injection performed in your radiology department Acquisition of the usual 4 mammographic views on the same mammography system 1 Install 2 Inject 3 Acquire 4 Review

7. Increase your diagnostic confidence High sensitivity for breast cancer diagnosis High specificity to reduce false-positives and help prevent unnecessary biopsies and surgeries An alternative imaging method to MRI when MRI availability is limited and for patients for whom MRI is contraindicated A new & accurate diagnostic exam Leverage a new problem-solving exam for inconclusive mammography High Sensitivity High Specificity

8. Improve your patients’ experience Don’t let your patients wait any longer to get a diagnosis! With SenoBright , you can give your patients a confident diagnosis the same day, in the same place, in less than 7 minutes after the inconclusive mammogram, with no limitation such as waiting time, contraindications or long exam time Reduce the anxiety* & release your patient immediately in case of negative exam *Hobbs et al. Journal of Medical Imaging and Radiation Oncology 59 (2015) 300–305

9. Reduce your diagnostic costs SenoBright is a cost-effective alternative diagnostic exam The high specificity of SenoBright helps you to reduce unnecessary biopsies & surgeries Free-up your MRI time for more demanding cases or other procedures $ Biopsies

10. Contrast-Enhanced Spectral Mammography helps to improve breast cancer diagnostics A hospital and university health center in the Midwest United States is using SenoBright , contrast-enhanced spectral mammography (CESM), to help obtain quick and definitive diagnoses . Clinicians have found the SenoBright technique from GE Healthcare to be an effective alternative to MRI as a follow-up to ambiguous mammograms, which are common in women with dense or nodular breast tissue. 10

11. Invasive Ductal Carcinoma 11

12. Extent of Disease and Neo -adjuvant Chemotherapy Monitoring 12

13. Case Solving : Negative 13

14. SenoBright , a clinically proven technology 14 * Estimates based on 350 sites, 4 exams/week during 3 years **Bibliography available on request More than 100 installations in the USA High diagnostic accuracy +200 000 exams * +350 Installations 100 in USA +100 Publications **

15. SenoBright Clinical cases

16. Invasive carcinoma – Case 1 Patient in her 50’s. right nipple retraction 16 Routine image CC view Routine image findings: Spiculated nodule, right midline central breast Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

17. Invasive carcinoma – Case 1 Patient in her 50’s. right nipple retraction 17 Routine image MLO view Routine image findings: Spiculated nodule, right midline central breast Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

18. Invasive carcinoma – Case 1 Patient in her 50’s. right nipple retraction 18 Ultrasound image findings: Spiculated nodule, (20x19 mm), right breast. associated with 2 satellite nodules Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

19. Invasive carcinoma – Case 1 Patient in her 50’s. right nipple retraction 19 CESM image findings: Four areas of suspicion (nodules), right breast. Sizes: 25 x 20 mm, 7 mm, 7 mm, 7 mm Biopsy result: Core biopsy ( spiculated nodule): Invasive ductal carcinoma Fine needle aspiration (Satellite): Invasive ductal carcinoma Surgery result: (bilateral mastectomy) Multifocal invasive ductal carcinoma Ductal hyperplasia Affected axillary lymph nodes SenoBright image CC view Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

20. Invasive carcinoma – Case 1 Patient in her 50’s. right nipple retraction 20 SenoBright image MLO view CESM image findings: Four areas (nodules) of suspicion, right breast. Sizes: 25 x 20 mm, 7 mm, 7 mm, 7 mm Biopsy result: Core biopsy ( spiculated nodule): Invasive ductal carcinoma Fine needle aspiration (Satellite): Invasive ductal carcinoma Surgery result: (bilateral mastectomy) Multifocal invasive ductal carcinoma Ducal hyperplasia Affected axillary lymph nodes Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

21. Invasive & in situ carcinoma – Case 2 Patient in her 30’s. Nodule detected by palpation in the right retroareolar region 21 Routine image findings: No findings Routine image CC view Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

22. Invasive & in situ carcinoma – Case 2 Patient in her 30’s. Nodule detected by palpation in the right retroareolar region 22 Routine image findings: No findings Routine image MLO view Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

23. Invasive & in situ carcinoma – Case 2 Patient in her 30’s. Nodule detected by palpation in the right retroareolar region 23 Ultrasound image findings: Malignant looking hypoechoic region (7,4 mm) with irregular borders. Benign nodules in the midline outer quadrant (12 x 6,5 mm) Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

24. Invasive & in situ carcinoma – Case 2 Patient in her 30’s. Nodule detected by palpation in the right retroareolar region 24 CESM image findings: One area (nodule) of suspicion, right breast, retroareolar region Biopsy result: Fine needle aspiration: Invasive ductal carcinoma Surgery result: (lumpectomy) Invasive ductal carcinoma associated with intraductal lobular carcinoma, 9x7x6 mm Ductal carcinoma in situ , several focus, 1 mm Axillary lymph nodes affected SenoBright image CC view Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

25. Invasive & in situ carcinoma – Case 2 Patient in her 30’s. Nodule detected by palpation in the right retroareolar region 25 SenoBright image MLO view CESM image findings: One area (nodule) of suspicion, right breast, retro areolar region Biopsy result: Fine needle aspiration: Invasive ductal carcinoma Surgery result: (lumpectomy) Invasive ductal carcinoma associated with intraductal lobular carcinoma, 9x7x6 mm Ductal carcinoma in situ , several focus, 1 mm Axillary lymph nodes affected Images courtesy of Dr. José Luis Cárdenas, Hospital Príncipe de Asturias, Alcalá de Henares –Madrid

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