Women's health news related to breast imaging, including mammography, breast MRI, automated breast ultrasound (ABUS), breast ultrasound, breast biopsy, and positron emission mammography (PEM). This channel also includes news on breast density and the issues it causes in detecting cancers. Mammography can be broken into two types of systems. 2-D full field digital mammography (FFDM) have almost completely replaced older X-ray film based systems. The newest generation systems use 3-D tomosynthesis mammography technology, where a series of digital images are shot in an arch around the breasts and a computer reconstructs the images into slices that can be scrolled through to see layers of tissue. This allows easier radiology reading of images, especially in women with dense breasts, because it can cancers where there are several layers of thick breast tissue that can mask cancers on 2-D mammography. Tomo is rapidly replacing FFDM.
Kubtec hosts a Podcast: Impact of COVID-19 on Breast Cancer Treatment with Andrea Madrigrano, M.D., as part of its public service campaign.
Table 1. Compared to 2-D mammography, which yields four images per patient, digital breast tomosynthesis (DBT), or 3-D mammography, produces hundreds of images per patient. While this provides more information for clinicians, the exponential increase in data can result in reader fatigue and burnout, which may ultimately affect patient care.
Figure 1. R MLO view from four different years. The skin mole is marked with a circular skin marker (TomoSPOT REF# 782, Beekley Medical) on the far-left image. These images demonstrate the potential for significant variability in location of the skin lesion due to movability of the skin during positioning.
Breast density is divided into four categories, from lowest to highest amounts of fibroglandular tissue composition. Category A: Almost entirely fatty (least amount of fibroglandular tissue). Category B: Scattered fibroglandular tissue. Category C: Heterogeneously dense. Category D: Extremely dense (most amount of fibroglandular tissue).
Images in a 57-year-old woman noted to have "good prognosis" invasive cancer detected at digital breast tomosynthesis (DBT) screening. (a) Craniocaudal view of the left breast obtained with the two-dimensional digital mammography (DM) portion of the DM/DBT screening study demonstrates a subtle area of distortion in the medial left breast. (b) Single-slice image from the left craniocaudal DBT portion of the screening study shows an area of bridging distortion (circle). (c) Electronically enlarged image of the area of concern seen on the left craniocaudal view in a single DBT slice as shown in b. (d) Targeted US scan demonstrates two small adjacent irregular solid masses. US-guided core biopsy yielded an invasive carcinoma of the tubular subtype that was estrogen receptor positive, progesterone receptor positive, and human epidermal growth factor receptor 2 negative. The results of the sentinel node biopsy were negative. Image courtesy of the Radiological Society of North America
Example: SoftVue image stacks of sound speed, as shown for cases ranging across the four Breast Imaging Reporting and Data System (BI-RADS) breast density categories ((a), fatty; (b), scattered; (c), heterogeneously dense; (d), extremely dense). Note the quantitative scale indicating that absolute measurements are obtained. Image courtesy of MDPI
Christopher Comstock, M.D., (Memorial Sloan Kettering Cancer Center) is the lead author of a paper in JAMA that reports that abbreviated breast MRI detected significantly more (almost 2 and a half times as many) breast cancers than digital breast tomosynthesis (3-D mammography) in average-risk women with dense breasts. Photo courtesy of Memorial Sloan Kettering Cancer Center