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IMAGING

DIGITAL MAMMOGRAPHY WITH 3D TOMOSYNTHESIS

After clinical examination by the breast surgeon, patient (>40 yrs) is subjected to mammography in our clinic- Digital mammography with 3D tomosynthesis. It detects Stage 0 of Breast Cancer and is particularly used for detecting cancer in Indian women, since they have dense breasts. It has a plastic screen instead of a metal one, making the procedure painless. It acquires a series of images in 90+ slices, making the procedure accurate and quick, taking only 3-4 seconds. Screening with mammography has resulted in 15-20% reduction in mortality due to breast cancer. Sensitivity of mammography is 68% & specificity is 75%.

  • Mammographic sensitivity for cancer detection varies
  • 85.7% - 88.8% in entirely fatty
  • 62.2% - 68.1% in extremely dense
  • Digital mammography: Improved sensitivity and accuracy for cancer detection relative to those of film-screen mammography in women with dense breasts (83.6% vs 68.1%, P = .051)
  • One of the major limitations of 2D mammography is due to tissue overlap. Overlapping tissue can obscure a lesion causing a false negative result (missed cancer 15-30%). DBT overcomes this limitation by creating 3D images of breast, obtaining multiple 1mm low dose slices of the breast from various angles as the xray tube moves in an arc over the breast. The images are reconstructed using an iterative reconstruction (not isotropic like CT/MRI). For the patient, nothing changes. Positioning, compression, views, time for procedure are pretty much the same. Reduces call back rates. Improves detection & characterization of breast lesions
  • After abnormality is seen in mammography, ultrasonography is performed by radiologist on ——– machine. Whole breast US Incremental cancer detection rate above that of mammography was 3-4 per 1000, has limited role for screening. (ACRIN 6666). It is Used for characterization of breast lesion. Cornerstone for diagnostic workup. Used extensively for biopsy guidance. It is modality of choice for palpable masses in young patients. It is Good for differentiating solid & cystic lesions and for For detection of axillary lymphadenopathy. Color Doppler and elastography further help for characterization of lesions.
  • Automated Breast Volume Scanner
  • Acquires whole series of consecutive B mode pictures & reconstructs 3D data sets of entire breast volume.
  • Depicts global breast anatomy & architecture.
  • Useful in multifocal lesions
  • Good for screening in dense breasts
Interventions:
  • Trucut biopsy- USG guidance
  • Vacuum assisted biopsy- for small lesions, papillary lesions, scarless removal of fibroadenomas
  • Stereotactic biopsy is performed if the lesion is not seen in USG i.e. microcalcifications.
BREAST ULTRASONOGRAPHY / ULTRASOUND (USG)

Ultrasound is an imaging test by which images of your breast can be viewed on a screen for detecting cancer, by sending high-frequency sound waves through it. It is the poor man’s MRI. At Orchid’s, we use ultrasound in combination with mammography, to increase the sensitivity of the test to nearly 90-95%.

  • Ultrasound is the best way to find out the type of an abnormality (whether it is a benign or a malignant tumour, a fluid-filled cyst or solid mass) seen on mammography or felt by physical examination and takes about 5 minutes.
  • It helps in better identification of very small breast lesions that are not easily felt by physical examination.
  • It is also used for detecting changes in the breast that can be felt but cannot be seen on a mammogram.
  • In case of a suspicious lesion, a USG guided needle biopsy is performed, where ultrasound is used to accurately guide the biopsy (tissue removed from the body for examination)
AUTOMATED BREAST VOLUME SCANNER (ABVS)

High-density breasts make it difficult to detect tumour in these breasts using a mammogram, as both the dense tissue and tumour appear white. This is a common occurrence in India and therefore, at Samarpan, we use the Automated Breast Volume Scanner (ABVS).

Why this technique?

  • ABVS is a standalone system that creates a 3D image of the entire breast, thus providing a comprehensive view of the breast and making tumour detection easy.
  • The most important aspect of this system is its automated scanner arm. This automated arm ensures precision, improved patient comfort and reproducibility, as it reduces human errors and does not depend on an operator for the process.
  • It can assess and store the breast scans, as well as provide a more understandable representation of the breast’s anatomy and architecture, thus making it efficient in detecting tumour.
MAMMOGRAPHY

After clinical examination by the breast surgeon, patient (>40 yrs) is subjected to mammography in our clinic- Digital mammography with 3D tomosynthesis (machine name). Screening with mammography has resulted in 15-20% reduction in mortality due to breast cancer. Sensitivity of mammography is 68% & specificity is 75%.

  • Mammographic sensitivity for cancer detection varies
  • 85.7% - 88.8% in entirely fatty
  • 62.2% - 68.1% in extremely dense
  • Digital mammography: Improved sensitivity and accuracy for cancer detection relative to those of film-screen mammography in women with dense breasts (83.6% vs 68.1%, P = .051)
  • One of the major limitations of 2D mammography is due to tissue overlap. Overlapping tissue can obscure a lesion causing a false negative result (missed cancer 15-30%). DBT overcomes this limitation by creating 3D images of breast, obtaining multiple 1mm low dose slices of the breast from various angles as the xray tube moves in an arc over the breast. The images are reconstructed using an iterative reconstruction (not isotropic like CT/MRI). For the patient, nothing changes. Positioning, compression, views, time for procedure are pretty much the same. Reduces call back rates. Improves detection & characterization of breast lesions
  • Automated Breast Volume Scanner
  • Acquires whole series of consecutive B mode pictures & reconstructs 3D data sets of entire breast volume.
  • Depicts global breast anatomy & architecture.
  • Useful in multifocal lesions
  • Good for screening in dense breasts
Interventions
  • Trucut biopsy- USG guidance
  • Vacuum assisted biopsy- for small lesions, papillary lesions, scarless removal of fibroadenomas
  • Stereotactic biopsy is performed if the lesion is not seen in USG i.e. microcalcifications.
ELASTOGRAPHY

During breast cancer, the elastic properties of the affected tissues are altered. Elastography is a new technique that detects this change in elasticity and maps it by imaging. It is non-invasive, so the patient need not worry about getting any scars. It is used for characterization of difficult areas. But, doesn’t sonography detect changes in the breast as well? Why should one opt for elastography instead? Elastography has a major advantage over sonography. Better resolution and clarity result in accurate detections. Whereas, sonography, alone, has the following limitations:

  • It cannot distinguish between ultrasound echoes of a normal and a cancerous tissue, that are produced equally.
  • It cannot capture areas deep inside the breast, affecting the imaging of dense breasts (as those seen in Indian women).
  • It may have trouble distinguishing from other pathologies.
  • It cannot show micro-calcifications
  • It cannot detect cancers at cellular level.
Benefits of elastography:
  • It is reproducible and easily performed.
  • It helps to characterize lesions detected on grey scale ultrasound.
  • It is useful in planning the management of masses that appear stiff (as they are suspected to be malignant).
  • It is used to analyze and differentiate between solid tumours, cysts and other areas of concern during breast ultrasound exams.