2D/3D Mammography, Density Assessment Software

Diagnostic Mammography
Diagnostic mammography is used to evaluate a patient with abnormal clinical findings—such as a breast lump or nipple discharge—that have been found by the woman or her doctor. Diagnostic mammography may also be done after an abnormal screening mammogram in order to evaluate the area of concern on the screening exam.

6. Kontos D, Winham SJ, Oustimov A, et al. Radiomic phenotypes of mammographic parenchymal complexity: Toward augmenting breast density in breast cancer risk assessment.Radiology2019; 290:41-49

Doctors take special care during x-ray exams to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards radiology professionals use.

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Breast density assessment software is costly and is not separately reimbursed by insurance carriers, nor are radiologists required to use it. Visual density assessment and software approaches show similar performance in identifying risk of screen-detected and interval cancer [8, 9].

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Benefits

18. Yi A, Chang JM, Shin SU, et al. Detection of noncalcified breast cancer in patients with extremely dense breasts using digital breast tomosynthesis compared with full-field digital mammography.Br J Radiol.2019;92(1093):20180101.

3D mammography (tomosynthesis): A standard 2D digital mammogram provides a 2-dimensional picture of the breast, which is a 3-dimensional object. The normal structures of the breasts (such as milk glands, fibrous tissue, fat, and blood vessels) overlap one another when viewed as a 2D image. Overlapping tissue can hide breast cancers and sometimes makes normal tissue look like breast cancer.

2D/3D Mammography, Density Assessment Software

New mammogram measures of breast cancer risk could revolutionise screening

14. Tabar L, Dean PB, Chen TH, et al. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening.Cancer2019; 125:515-523

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Additional Information and Resources

28. Lowry KP, Coley RY, Miglioretti DL, et al. Screening Performance of Digital Breast Tomosynthesis vs Digital Mammography in Community Practice by Patient Age, Screening Round, and Breast Density.JAMA Netw Open. 2020;3(7):e2011792.

Mammograms are used as a screening tool to detect early breast cancer in women experiencing no symptoms. They can also be used to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain, skin dimpling or nipple discharge.

Breast image generated with dedicated breast PET/CT. Orange and purple represent areas of increased metabolic activity which indicate the presence of a tumor. Source: John Boone, Ph.D., UC Davis

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Large population studies have shown that screening with breast tomosynthesis results in improved breast cancer detection rates and fewer “call-backs,” instances where women are called back from screening for additional testing because of a potentially abnormal finding.

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For information on coronavirus (COVID-19) or how COVID-19 vaccine side effects could affect your imaging results, see the Medical Imaging and Coronavirus Safety page.

Adding 3D/tomosynthesis to 2D digital mammography increases cancer detection by 1 to 2 cancers per thousand individuals screened. Several studies [15, 16] have shown there is a benefit to having 3D/tomosynthesis every year as it improves cancer detection. In studies done in the USA, 3D/tomosynthesis also reduces the number “call-backs” or “recalls” for additional testing of findings that turn out not be cancer (known as false positives)[17]. European-based studies have not shown a reduction in false positives [17, 18], likely due to low recall rates in Europe even with 2D mammograms.

You will feel pressure on your breast as it is squeezed by the compression paddle. Some women with sensitive breasts may experience discomfort. If this is the case, schedule the procedure when your breasts are least tender. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used. Always remember compression allows better quality mammograms.

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Although the radiation dose for some breast tomosynthesis systems is slightly higher than the dosage used in standard mammography, it remains within the FDA-approved safe levels for radiation from mammograms. Some systems have doses very similar to conventional mammography.

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What is Mammography?

Figure Mammo-4. Comparison of breast cancer visibility in a fatty breast versus a dense breast.

A radiologist, a doctor trained to supervise and interpret radiology examinations, will analyze the images. The radiologist will send a signed report to your primary care or results with you.

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