Cancer Treatment Today » Mammography http://cancertreatmenttoday.org Knowledge is Power Thu, 26 Mar 2026 23:39:25 +0000 en-US hourly 1 Breast tomosynthesis: a new mammography – pro http://cancertreatmenttoday.org/breast-tomosynthesis-a-new-mammography-pro/ http://cancertreatmenttoday.org/breast-tomosynthesis-a-new-mammography-pro/#comments Fri, 24 Aug 2012 17:58:36 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=5217 Breast tomosynthesis is a 3-dimensional (3-D) imaging technology that involves acquiring images of a stationary compressed breast at multiple angles during a short scan. The individual images are then reconstructed into a series of thin high-resolution slices that displayed individually or in a dynamic ciné mode. Tomosynthesis can reduce or eliminate the tissue overlap effect. While holding the breast stationary, images are acquired at a number of different x-ray source angles. Objects at different heights in the breast project differently for each angle. The final step in the tomosynthesis procedure is reconstructing the data to generate images that enhance objects from a given height by appropriate shifting of the projections relative to one another. Tomosynthesis has many properties that make it suitable as a modality for screening, including good diagnostic performance, short examination time and low radiation dose, it is a strong competitor to the current gold standard breast screening modality, i.e. mammography. At the same time, theoretical advantages have not yet been shown to translate into clinical advantage or even equivalence to standard mammography.

Metanalysis by Lei et al concluded: “Digital breast tomosynthesis has high sensitivity and specificity in breast diagnosis.• DBT appears to have superior diagnostic accuracy relative to digital mammography. • DBT images were captured at a lower dose than 2D images. • DBT displays abnormal features of lesions more clearly than DM. • Digital breast tomosynthesis could become the first choice for assessing breast lesions.”

In a statement in November 2014, while calling for more studies, the American College of radiology said:: To be clear: tomosynthesis is no longer investigational. Tomosynthesis has been shown to improve key screening parameters compared to digital mammography. “.

Yoo JY, Chung MJ, Choi B, Jung HN, Koo JH, Bae YA, Jeon K, Byun HS, Lee KS. Digital tomosynthesis for PNS evaluation: comparisons of patient exposure and image quality with plain radiography.  Korean J Radiol. 2012 Mar;13(2):136-43. Epub 2012 Mar 7.

Tingberg A  X-ray tomosynthesis: a review of its use for breast and chest imaging. Radiat Prot Dosimetry. 2010 Apr-May;139(1-3):100-7

ACR Statement on Breast Tomosynthesis, November 24, 2014. http://www.acr.org/About-Us/Media-Center/Position-Statements/Position-Statements-Folder/20141124-ACR-Statement-on-Breast-Tomosynthesis

Lei J, Yang P, Zhang L, Wang Y, Yang K.Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis. Eur Radiol. 2014 Mar;24(3):595-602.

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]]> http://cancertreatmenttoday.org/breast-tomosynthesis-a-new-mammography-pro/feed/ 0 MRI to screen preoperatively for DCIS – pro http://cancertreatmenttoday.org/mri-to-screen-preoperatively-for-dcis-pro/ http://cancertreatmenttoday.org/mri-to-screen-preoperatively-for-dcis-pro/#comments Wed, 20 Jun 2012 23:41:26 +0000 M Levin, MD http://cancertreatmenttoday.org/?page_id=1479 Most guidelines recommend breast MRI for screening in women with high-risk of developing breast cancer and to clarify diagnostic uncertainties after mammography and ultrasound. As use of MRI has increased, many other situations for which, MRI might be helpful came to the fore. Unfortunately, literature support for most of them, is lacking.

Currently, guidelines indicate MRI for screening of women at high risk based on family history or for clarifying diagnostic dilemmas that are unable to be clarified by mammography and ultrasound. Some physicians adopt the strategy of using MRI to decide between a mastectomy and lumpectomy, when DCIS is present. The reasoning is that if widespread DCIS is found, a mastectomy would be performed rather than a lumpectomy. This strategy has not been formally evaluated and is not recommended by guidelines. A clinical trial is ongoing: Breast MRI as a Preoperative Tool for DCIS, NCT00605982. The purpose of this study is to see how often MRI can find other areas of cancer in women with one area of breast cancer, and to determine how having the MRI test affects their treatment.  The study also aims to follow women who enter the study over a 10-year period to determine how often the breast cancer comes back.

ACR says: ” Invasive carcinoma and ductal cardinoma in situ (DCIS) – Breast MRI may be useful to determine the extent of disease and the presence of multifocality and multicentricity in patients with invasive carcinoma and ductal carcinoma in situ (DCIS). MRI can detect occult disease up to 15% to 30% of the time in the breast containing the index malignancy. MRI determines the extent of disease more accurately than standard mammography and physical examination in many patients. It remains to be conclusively shown that this alters recurrence rates relative to modern surgery, radiation, and systemic therapy.”

REFERENCES:

Kuhl CK, Schrading S, Bieling HB, et al. MRI for diagnosis of pure ductal carcinoma in situ: A prospective observational study. Lancet. 2007;370(9586):485-492.

http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/breast/MRI_Breast.pdf – 2008

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