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3D Mammography (Tomography) Conventional Mammography

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3D Mammography (Tomography) Conventional Mammography Jon E. Ekstrom, MD I have no relevant financial disclosures Breast Carcinoma 1 in 8 U.S. Women will develop Breast CA In 2015 estimated 231,840 new cases of invasive breast CA and 60,290 new cases of in situ disease. In 2015, 40,290 Breast CA deaths are expected with mortality rate decreasing since 1989. In 2015, there are more than 2.8 million women in the U.S. with current or past history of Breast CA. Breast CA in Oregon Oregon is ranked the 2nd highest in the nation for Breast CA incidence (128.6/100,000) WA is # 1. Leading cancer Dx in Women from all racial and ethnic groups. The % of early stage (localized and in situ) is 74% The mortality rate of Breast CA in OR is lower than the national average. ? Northwest has high rate of Breast CA screening and large population of older white women who may have better outcomes than many minorities Screening Mammography Recent conflict and debate Population based policy vs individualized medicine. In most practices, 10 – 15% of new Breast CA diagnosis are in women less than age 50. We cannot reliably inform a patient when it is safe to postpone screening. 1/6 Breast CA deaths attributed to diagnosis in 40’s 1/3 of all years of life lost to Breast CA are from diagnosis before age 50. Breast Density and Cancer Risk Increased Breast density is a marker of increased risk for developing Breast CA. No Increase in Breast CA Mortality. BIRADS Lexicon. No Standardization (subjective) Decreased Detection of Breast Ca. ? Surrogate Marker of cellular proliferation. ?Reflection of endogenous hormone environment. Is past or current breast density most important to establish risk? Breast Density Mammography History Standard X-Ray Mammography (-1930) Xerox Mammography (1970 – 1985) Film / Screen Based Mammography (1980s – 2010) Digital Mammography (2005 – Current) 3D Mammography (Tomography) Conventional Mammography Tissue superimposition Projection imaging X-rays Compression Plate Breast Detector Problems Often unclear detection method High amounts of over-diagnosis and under-diagnosis This leads to multiple unnecessary screenings and more exposure to X-ray radiation Limited 2-dimensional image leaves about 10% of cancers undetected Denser breast tissue is difficult to read in some patients 3D Mammography=Tomosynthesis First system approved by FDA – 2011 System acquires multiple images of the Breast through a moving Beam. Images are reconstructed at 1 mm slices. 2D image is generated from the tomosynthesis data Tomosynthesis Tomosynthesis Utilizes low-level X-rays to produce multiple images of the breast, layer by layer, using a swinging camera This layering of images makes it simpler to detect normal breast structures (milk ducts, lobules, fatty tissues, etc.) from cancerous ones X-rays are converted into limited 3- dimensional digital images for radiologists to examine Computer Aided Detection (CAD) assists in spotting regions where cancer seems to be present Dense tissue is more easily examined through Tomography than traditional Mammography Digital Breast Tomosynthesis Tomographic Imaging X-rays Tube Rotation Compression Plate Breast Detector • WhyTissue superimposition 3D Mammography/DBT? : • hides pathologies in 2D • mimics pathologies in 2D Why 3D Mammography? 16 Tomosynthesis: A Better Mammogram ADVANTAGES DISADVANTAGES Higher Detail Longer Interpretation Helps Delineate Time Overlapping Tissues More Costly (>80 % of Increased CA Detection Carriers are Covering) Rate Still Difficulties with Decreased Call Back Uniformly very dense Rate Breast Tissue Tomosynthesis (cont.) Increases detection of Invasive breast cancers by 40% in comparison to 2D mammography Total cancer detection increased from 6.1 patients per thousand to 8.0 patients per thousand (a 27% increase) False-positive readings reduced by 15% Uncertain readings and patient call-backs reduced by 20-30% Clinical Performance: Overall CA detection Rate increased 27% over Digital Mammography (Oslo trial – 12,631 screenings in 2 yrs) False Positive Rate Decreased by 15% Tomosynthesis EXAMPLE same tissue 2D Mammography 3D Mammography (slice 17) A suspicious region A highly suspicious region Hologic – Proprietary and Confidential EXAMPLE same tissue 2D Mammography 3D Mammography (slice 22) A worrisome region A very worrisome region Hologic – Proprietary and Confidential Reduced Call Backs Reduced Call Backs Tomosynthesis 2D images from Tomosynthesis Data (C View) Hologic (2011). Reduce Exposure Time and Dose. Dose is equivalent to Conventional Digital Mammography. Tomosynthesis Example 8/10/2015 Digital Mammo 8/20/2015 Tomo Mammo Ultrasound Findings 3:00 Lesion 1:00 Lesion Tomosynthesis: Additional Advantages More accurate Characterization of Lesion Size Able to Locate Difficult Lesions in 3 Dimensions Image Guided Biopsy Systems Contrast Enhanced Mammography Guided Biopsy Localize Target in x,y, and z Planes. More Comfortable than Prone Stereotactic Table Contrast Enhanced Tomo Contrast Enhanced Tomo Patients who are not MRI Candidates Where MRI is not Available Reduced Cost over MRI Still a Work in Progress Thank You.
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