Adding Tomosynthesis to standard mammography improves breast cancer screening, reduces radiation level

Dr. Lisa Weinstock, Director of Women's Digital Imaging in Ridgewood, said she has added Hologic Low-Dose 3-D Mammography (Breast Tomosynthesis) with C-View 2-D Imaging to enhance breast cancer screening of patients. The C-View 2-D imaging software, which just became available this year, reduces the radiation level of Tomosynthesis to that of a standard mammogram. A study presented at the December 2014 annual meeting of the Radiologic Society of North America found that adding Tomosynthesis to standard mammography increased the number of cancers detected and decreased the amount of false positives compared to mammography alone.

Tomosynthesis produces images that appear to be three dimensional, giving radiologists better visualization of the breast tissue. In standard digital mammography, there is overlap of the normal breast tissue, making abnormalities harder to see. With Tomosynthesis, the camera moves over the breast in an arc taking pictures in slices that can be viewed one millimeter at a time. By scanning through the breast images slowly, tiny masses and areas of distortion can be seen that may not be visible when all the breast tissue is overlapped on one view.

The C-View 2-D imaging software converts the images from 3-D to the standard 2-D, which produces a composite picture of all the images together. Patients experience half the amount of radiation as well as half the time spent in compression compared to Tomosynthesis exams without C-View.

Dr. Weinstock said that while Tomosynthesis is the newest tool available to screen for breast cancer, it is not the only one we need.

https://youtu.be/13fDNlU8doA

"Tomosynthesis is an updated version of the mammography picture. But it is not enough. You have to know if you have dense breast tissue and if you need Ultrasound, MRI or molecular imaging."

In "The Benefits and Limitations of Tomosynthesis," Dr. Weinstock shows how Tomosynthesis was able to prove a suspicious area was benign in one patient, but could not see through the dense tissue of another patient. On mammography images, including Tomosynthesis, tissue and cancer are both white. A large amount of dense, fibrous tissue can obscure a cancer. With Ultrasound, tissue is white but cancer is gray and therefore more visible.

Dr. Weinstock said she will continue to recommend supplemental imaging when necessary. She cited Dr. Jean Weigert's studies in Connecticut which consistently show that Ultrasound finds an additional 3 cancers per 1,000 women screened. MRI and molecular imaging are also important screening tools because they show metabolic activity, how cells behave, not just the anatomic picture.

"Each modality shows images differently," Dr. Weinstock said. "Working together, they improve early detection of breast cancer."