Tomosynthesis: An Advance in Imaging Breast Cancers

January 1, 2013

Three-dimensional mammography provides better detection 

Innovations in Cancer - Winter 2013 - View Full PDF 
 

DONNA PLECHA, MD

Director, Breast Cancer Imaging, UH Seidman Cancer Center, Associate Professor of Radiology, Case Western Reserve University School of Medicine

Early detection is key in the treatment of breast cancer. In fact, when breast cancer is detected early and confined to the breast, the five-year survival rate is now 98 to 100 percent. A major advancement for detection, tomosynthesis, is now available at the Breen Breast Health Pavilion, which is connected to UH Seidman Cancer Center. Tomosynthesis is an innovative technology that provides detailed, three­dimensional, exceptionally sharp images of the breast. It is an important new tool in our arsenal to detect breast cancer early. Tomosynthesis is also currently available at our UH Chagrin Highlands Breast Center. It will be available in 2013 at our UH Westlake Health Center.

During the test, the new system takes both standard digital mammograms and tomosynthesis images - nearly 200 1-millimeter-thick images for an average­sized breast, compared with four images in a regular 2-D digital mammogram - during the same imaging sweep of the breast. The machine's X-ray tube makes an arc over the patient, taking a series of low-dose images from different angles, similar to a CT scan. The additional images are then synthesized by a computer into a more detailed, highly focused, 3-D reconstruction of the breast. This can be viewed in 1-millimeter slices.

UH uses the Selenia® Dimensions® 3-D digital mammography system, manufactured by Hologic and approved by the FDA in early 2011.

Single thin slice from the 3-D tomosynthesis mammogram through the left breast showing a cancer that was not seen on the 2-D mammogram.

By providing added detail, the 3-D images allow radiologists to identify and characterize individual breast structures and clearly see features that might otherwise be obscured. Dense tissue and overlapping tissue structures can lead to false positive or false negative results with standard 2-D mammography. Tomosynthesis helps radiologists more readily pinpoint the location, size and shape of the tumors, hopefully while they are small, early stage cancers. Recent studies of 10,000 to 25,000 women screened with tomosynthesis have shown 47 to 61 percent increases in cancer detection rates compared with 2-D digital mammography.

Tomosynthesis may also decrease the number of women who need to return for additional testing when a potential abnormality is detected. These return visits, which affect about 10 percent of mammography patients nationally, can be very stressful and can lead to additional patient costs when insurance plans consider them as diagnostic rather than screening mammograms. Studies have shown a decrease in callback rates of 30 to 38 percent with tomosynthesis compared with 2-D mammography.

Tomosynthesis provides more detailed, clearer views than traditional 2-D mammography, and recent studies have shown it to be beneficial for all patients when screening for breast cancer. Our patients are now offered the option for tomosynthesis when they arrive for their screening mammography. The entire process takes approximately the same time as standard, 2-D digital mammography alone, and the amount of breast compression is identical to a conventional mammogram.

Our best defense against breast cancer is detecting it early and curing it at a more treatable stage, and tomosynthesis provides us with an important new tool to decrease cancer mortality and save lives.

To discuss tomosynthesis with Donna Plecha, MD, call 216-844-5330 or email Donna.Plecha@UHhospitals.org

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