Tomosynthesis: 3D mammography

A better view of the tumor: three-dimensional images could make breast cancer early detection even more precise, doctors believe. But the current study situation is unclear

As if broken down into slices: Using series of images of the breast, doctors can find tumors more quickly and recognize them better

© Mauritius / AllScience / BSIP

The diagnosis is made more than 70,000 times a year in Germany. Breast cancer is by far the most common tumor disease in women in this country. Many patients are younger than 55 when they get this result - at an age when other types of cancer are still quite rare.

But the chances of recovery are now great, only 25 percent of those affected die because of the tumor in their breast. The prognoses are usually particularly good if the cancer was discovered early.

X-ray in 3D

The most important method of early detection is mammography, an X-ray examination of the breast that is offered to women between 50 and 69 years of age even without suspected breast cancer. Another method has been available for around ten years: tomosynthesis. It should be more precise. But does the method bring an improvement? Could it even replace mammography at some point?

Professor Sylvia Heywang-Köbrunner heads the Mammography Reference Center in Munich

© W & B / Thomas Dashuber

As with mammography, tomosynthesis is an X-ray examination of the breast - but in 3D. The device moves gradually around the chest, x-raying it from different angles.

"In this way, a series of images is calculated with which we can look at the inside of the breast as if dismantled into slices," says Professor Sylvia Heywang-Köbrunner, head of the Mammography Reference Center in Munich.

The better mammography?

In a two-dimensional image it could happen that a change is hidden behind dense glandular tissue and is difficult or impossible to recognize and interpret. "If, on the other hand, we have slice images available, we can virtually expose the suspicious area on the screen."

"This is particularly beneficial for women whose breasts have dense, irregular tissue," explains Dr. Christian Albring, President of the Professional Association of Gynecologists. But that only affects a small proportion of women over 50 years of age. Because from the menopause, the glandular tissue in the breast is gradually replaced by fatty tissue. This makes it easier to identify tumors.

Tumor in the breast

© W & B / Veronika Graf

TO THE PICTURE GALLERY

© W & B / Veronika Graf

This tumor, hidden by dense tissue ...

© Breast Diagnostics Munich, Prof. Dr. S. H. Heywang-Köbrunner

... can only be recognized on the three-dimensional image.

Previous

1 of 2

Next

In fact, studies show that tomosynthesis can detect more tumors than conventional mammography. In addition, women had to be frightened less often because of unclear findings and had to be examined again. For some experts like Professor Per Skaane, head radiologist at the University Hospital Oslo (Norway), tomosynthesis is "simply the better mammography".

What does tomosynthesis bring?

However, there are significant regional differences in the studies that differentiate between two- and three-dimensional mammography. The lower rate of re-examinations was particularly significant in the USA, where different standards apply than ours. "Screening doctors in Germany are very experienced and discover a lot during mammography that less trained eyes do not notice," says radiologist Heywang-Köbrunner.

Dr. Christian Albring, President of the Professional Association of Gynecologists

© W & B / Stefan Thomas Kröger

It remains to be seen whether the new method can really reduce the number of women dying from breast cancer. "We have to ask ourselves, for example, whether we can use tomosynthesis to discover rapidly growing tumors that require rapid action," says Heywang-Köbrunner - or whether it is mainly slow-growing tumors that would have been sufficient, she said to be found at the next mammography examination.

Experienced eyes asked

"At the moment tomosynthesis is an additional method that is used when the findings are unclear," explains gynecologist Albring. It is not approved as the sole screening method in Germany - not only because of the higher costs.

Experienced radiologists are also required to interpret tomosynthesis images. Such experts can mainly be found in mammography screening centers. "This is where most of the 3D mammography devices in Germany are currently located," said Albring. "And studies are being carried out there to better research the advantages and disadvantages of the method."

Look inside the chest: alternative procedures

In addition to mammography, other imaging methods are used for breast examinations - at least in addition:

Ultrasonic

The radiation-free method uses sound waves. Depending on the density of the fabric, these are transmitted or reflected to different degrees. The glandular and connective tissue appear light in the image, while tumors and nodules are often dark.

The method is considered a useful addition to mammography; the costs for the examination are reimbursed by the health insurance company, for example in the event of unclear findings or an increased risk of breast cancer. It is not recommended as the sole method for early detection. Its use as a self-pay service (IGeL) for women under 50 is controversial.

Digital mammography

Instead of exposing a film as with conventional X-rays, a so-called radiation detector system is used. Rays penetrate different types of tissue to different degrees. The resulting images are sent directly to a computer. There, recordings can be enlarged quickly and easily and computer-aided diagnostic programs can be used.

Another advantage: a lower radiation dose. The technology has been used across the board in the German screening program since 2012 and has largely replaced X-ray films.

Breast MRI

Magnetic resonance imaging (MRI) is the most expensive procedure in breast cancer diagnostics - but it is also the one that can detect most of the changes.

The costs are currently only covered under certain conditions. These include, for example, a high familial risk and checking the success of the therapy in the case of existing breast cancer. It is controversial whether the breast MRI is also useful for other patients. Therefore, in this case you have to pay for it yourself.

Galactography

This special X-ray examination of the milk duct system is hardly used anymore. The milk ducts are made visible by means of contrast media, for example when the breast secretes fluid for no apparent reason. Then the health insurance company will also cover the costs.