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Using breast tomosynthesis (3D screening) in the image on the left (one of about 50 thin breast sections), you can see a tumor about 1 cm wide that is not clearly visible on the breast. the mammogram image on the right, even if the breast does not contain particularly dense tissue. Image: Skåne University Hospital in Malmö. Credit: University of Lund
In traditional mammography screening, all breast tissue is captured in a single image. Breast tomosynthesis, on the other hand, is three-dimensional and works on the same principle as what is known as tomography. This means that several low-dose x-ray images are taken from different angles of the breast, which are reconstructed by a computer to show thin layers of the breast. With more and better image information and less nested tissue structures, the chances of detecting tumors increase. In addition, the radiation dose may be reduced under certain circumstances.
"With breast tomosynthesis, the number of cancerous tumors detected increased by 34% over current standard mammography screening, while at the same time we were able to reduce breast compression during the examination, which could encourage more women to participate in screening, "says Sophia Zackrisson, associate professor at Lund University and radiologist at Skane University Hospital (SUS). "However, we had to recall a few more women for additional exams compared to traditional mammography, and we had to confirm that these women did not have cancer, because this method detects more structures in the breast in general. Needed to improve screening for many women and breast tomosynthesis is clearly the most appropriate method for switching to breast cancer screening. "Breast tomosynthesis will be introduced.
Breast tomosynthesis is already being used at Skåne University Hospital, among other things, to investigate suspected breast cancer. Before a possible large-scale introduction into the general breast cancer screening program, the research team is currently conducting a cost-benefit study.
All types of screening carry a risk of overdiagnosis, which can lead to unjustified treatment. Therefore, the research team, in collaboration with its European colleagues, will conduct a metastude in which it will consolidate and analyze the results of its collective research.
The lack of radiologists able to revise the increase in the number of images generated by 3D methods presents an additional challenge before a large-scale introduction. However, the method used at Skåne University Hospital could be more effective than those previously examined in international studies. In Scania, only the 3-D method was used, while other studies have associated 3-D screening with conventional mammography screening. This leads to more imaging equipment and a higher radiation dose.
"We have shown that we can achieve the same result with a simpler and perhaps even better method," says Sophia Zackrisson.
In the future, some parts of the breast tomosynthesis image review may be automated using computers, but this will take time. There is currently a lack of suitable software ready for use and tested. Studies are underway, especially within the research team of Sophia Zackrisson.
Explore further:
New method detects more breast cancer during screening
More information:
Sophia Zackrisson et al. Breast tomosynthesis at a glance versus dual-view mammography in the Malmö breast tomosynthesis screening test (MBTST): prospective population-based diagnostic accuracy study Lancet Oncology (2018). DOI: 10.1016 / S1470-2045 (18) 30521-7
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