Digital Mammography & Tomosynthesis

What is mammography?

A mammogram is a special type of x-ray of the breast. It is performed by technologists using a special machine, the mammograph. It uses the minimum amount of X-rays so that the woman is burdened as little as possible. Clearly pregnant women and those under 35 years of age are prohibited from having a mammogram under normal circumstances.

What makes mammography so important?

Mammography is the most important, most widely used and easiest to use tool for early diagnosis of breast cancer. What does early diagnosis mean? The discovery of a tumor before it becomes palpable. Why is this important?

• First, because then the disease is fully curable, as we discussed on the breast imaging page.
• What is the other advantage of early diagnosis? The excellent cosmetic effect of breast cancer surgery that can be achieved while the cancer is still small.

Mammography, finally, allows us to change the older belief that breast cancer is a fatal disease and breast surgery is a disfiguring procedure.

What are the types of mammography?

1. Preventive mammography: This is mammography done on healthy women without symptoms. It aims to find very small tumors with excellent prognosis and excellent aesthetic results from surgery. It is done by technologists and read by radiologists at another time, in a quiet environment without distractions. A typical mammographic screening includes 4 images, one vertical and one horizontal oblique for each breast

   

2. Preventive Mammography: Sometimes there is a finding on a screening mammogram that is not quite clear enough. Then radiologists may want to repeat a shot or do some of the less common specialized shots. The most common of these are magnifying shots that isolate the lump from the rest of the breast. They are performed in the presence of the radiologist, with differential positioning of the woman on the mammograph.

   

   Modern types of mammography:

Physical Mammography – Advantages

Nowadays almost all radiology centers are equipped with digital mammographs. Digital mammography has many advantages over analogue mammography:

• The existence of the image in digital format allows for easy storage of the image to be available forever as a benchmark. This allows your radiologist to understand any changes that may occur in the future
• Also, the digital format allows for high-resolution viewing on a screen, instant magnification and improved image quality.
• The breast surgeon can have the ability to access and store the images for use in the operating room as well.
• The use of digital technology gives the additional option of using computer assisted diagnosis systems, CAD mammography (computer assisted diagnosis). These are software that scan mammograms for abnormal findings and indicate them to radiologists.

Digital Breast Tomosynthesis (also known as 3D mammography)

Tomosynthesis is the newest development of mammography. It gives higher resolution images with the ability to detect smaller tumors and clarify suspicious findings. False positive findings occur much less frequently in tomosynthesis. This mitigates unnecessary investigations and the stress they entail.

When do I have my mammogram?

When is my mammogram done during a woman’s period?

Mammography (digital mammography or tomosynthesis) is done in the first 10 days of the cycle. It is preferable to have a clinical examination, breast ultrasound and magnetic mammography at the same time. So make your appointment with your radiologist somewhere between the 4th and 10th day of your cycle.

At what age and after what age can digital mammography be done?

Mammography is regularly done once a year from age 40 onwards. If breast cancer is discovered by histological examination in young women, mammography is performed regardless of age.

Reference digital mammography (or reference tomosynthesis)

Before the age of 40, between the ages of 35 and 39, a woman’s first mammogram, the reference mammogram, can be done. This should be kept by the woman, either as a film or in digital format (CD). This is necessary so that comparisons can be made and changes can be found in relation to subsequent examinations.

Small breasts (fibrocystic or fibrous breasts) on mammography

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Many women have seen “dense breast”, “dense fibrocystic breast”, “dense fibrous breast”, “dense fibroadenoid breast” on their mammogram reports. Few women, however, know what these mean. So let’s see what dense breast is.

What is breast density?

• Increased breast density on mammography means that a woman’s breast is made up of more glandular and fibrous elements, which are visualized as white
• Decreased breast density on mammography means that a woman’s breast is composed more of fatty element, which is the gray element on mammography

ACR classification for dense breasts:

1. ACR A: The breast is fatty with minimal fibrocystic and glandular elements. It is the most readable type of mammogram.
2. ACR B: There are scattered fibrocystic elements in the breast that do not make mammography particularly difficult to diagnose

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3. ACR C: Heterogeneously dense breast, with areas of very dense and unreadable but also areas of fatty very clear
4. ACR D: Extremely dense breast, the most illegible mammogram

What are the factors that increase breast density on mammography:

• Productive ages of the woman
• Pregnancy and Lactation
• Hormonal drugs such as hormone replacement therapy
• Weight loss (reduction of breast fat)
• Morbid breast conditions such as mastitis
• Cancerous breast conditions, such as inflammatory breast cancer

What are the factors that reduce breast density on mammography:

• Ages after menopause
• Old age
• Drugs that block female hormones
• Weight gain (more breast fat)

I have very dense breasts, what should I do?

• Women with ACR category C or D breast density should have a Breast Ultrasound along with their mammogram
• The breast screening plan should be followed to the letter, both the radiological examinations and the visit to your mastologist

Conclusion: BI-RADS (or BIRADS)

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For the BI-RADS categorization 0 to 6 see here.