In the effort to detect early forms of malignancy as early as possible, more and more imaging methods are used.

Despite this, mammography continues to be the method by which the first diagnostic approach to the breast is made. In particular, randomized controlled trials have proven that early detection of breast cancer through mammography has reduced mortality by 30%. Now statistical studies have proven that with preventive imaging programs the mortality from breast cancer is reduced to an even greater percentage in women over the age of 40.

What is tomosynthesis?

Tomosynthesis or three-dimensional (3D) mammography is the evolution of simple digital mammography.

“The breast is a three-dimensional organ, but it is depicted on a two-dimensional film. In order to highlight it as best as possible during simple or two-dimensional mammography, two shots are used on each breast, thus depicting it from two different angles. However, there are images that cause concern and create a false image of alteration, due to the projection of the elements of the breast which, however, are at a different depth”, points out Mr. Stamatis Merkouris Radiodiagnostic Director of the Metropolitan General Breast Center.

“During tomosynthesis, radiation is sent to the breast at different multiple angles, creating detailed mammographic images as it is possible to dissect the breast into thin slices one millimeter thick. This whole process is done automatically within seconds. The positioning of the examinee in the 3D mammogram is done in the same way, the duration of the tomosynthesis is slightly longer than the simple digital mammography and the radiation is similar.

With the image we get from tomosynthesis, we study the breast in successive, thin slices in a way that resembles the process of turning the pages of a book, thus significantly increasing the discriminating ability of the method.

It can be used in the context of planned preventive imaging in women who present without any symptoms, instead of the classic mammography. But also for the investigation and clarification of palpable findings or imaging findings resulting from the simple two-dimensional mammography” he emphasizes.

Advantages of Tomosynthesis

“When tomosynthesis is used as a preventive imaging modality, a combination of 2D and 3D imaging is created which has been shown to have significant advantages in breast imaging,” he continues, analyzing the advantages of tomosynthesis.

• Reduction of additional special charges. When standard mammograms show findings with suspicious characteristics, it is necessary to investigate them in a review with special mammograms. Several times it turns out that the finding was false and a result of the limitations of simple 2D mammography as a method. However, from the time of the first reception to the final result, there is a significant time delay and an additional increase in both the total cost of the examinations and the total radiation received by the examinee. But the most important thing is that it causes intense anxiety to the examinee, for no reason, since in essence it is a physiological examination, something that can be avoided by choosing tomosynthesis for breast imaging from the beginning. And in fact, without a burden in terms of radiation, since tomosynthesis scans have similar radiation to simple mammographic scans.

The only case where special images are necessary after tomosynthesis is the presence of microcalcifications, where special magnified images are necessary to clarify and monitor them according to the guidelines.

• Detection of more malignancies than simple digital mammography. Studies have shown that the combination of two-dimensional and three-dimensional mammography, leads to the detection of two additional cases of breast cancer in every 100 women who come for a preventive check compared to the simple mammography.

• Increasing the diagnostic ability to detect malignancies in dense breasts. Two-dimensional mammography presents difficulty in diagnosing malignancies, especially when the breasts are dense. The density of the breast is related to the ratio of the elements that make it up. Each breast is made up of glandular tissue, which includes the glands and milk ducts (the “white” part of the mammogram) and fatty tissue that surrounds it (the “gray” part of the mammogram). The greater the concentration of the glandular component, the denser the breast texture (and the whiter the breast). Unfortunately, most forms of malignancy are also “white”, meaning they have a similar radiopacity to the glandular tissue and can easily be hidden within it, especially when the breast is very dense, thus making their detection very difficult. Tomosynthesis, by analyzing the image of the breast throughout the depth per millimeter, enables the radiologist to study with much greater precision areas of increased radiolucency, thus providing a solution to one of the most important limitations of simple digital mammography.

Mammomat Revelation mammography system

Metropolitan General’s Breast Center is one of the few centers in the country to have the world-leading Mammomat Revelation mammography system, which ensures the most accurate and rapid diagnosis. In addition to tomosynthesis, it is capable of performing digital mammography, 2D & 3D reconstruction images, contrast mammography, stereotactic biopsy and tomosynthesis biopsy. It has innovative technical features that significantly improve the overall diagnostic result of tomosynthesis, with a reduced radiation dose of up to 30%. Specifically:

• Wide Angle Breast Tomosynthesis. Only the Mammomat Revelation system has a 50˚ capture angle, the largest capture angle in the world (unlike other tomosynthesis machines that have much smaller scan angles eg 15˚). This is an important difference because the wide angle gives better and more information. In total, 25 images are used in this particular system to render the 3D image, resulting in the highest possible resolution and better separation of the different breast structures. This leads to greater certainty in the diagnosis, increasing the possibility of detecting even the smallest lesions in the breast, reducing false positive or negative results and the need for additional complementary testing.

• The innovative PRIME technology allows the radiation dose to be reduced by up to 30%, with the best possible image.

• Insight 3D imaging capability that allows the creation of a truly 3D video effect that is immediately understandable.

• Automated measurement of breast density. Increased density is considered an important risk factor for breast cancer, while according to the latest international guidelines all patients with dense breasts should also be examined with tomosynthesis.

• Automated personalization of breast compression that reduces the intensity and duration of the compression resulting in a reduction of discomfort for the examinee. The higher the compression, the better the tissue separation and the sharper the image.

Tomosynthesis, the evolution of mammography

“In summary, mammography has contributed decisively to the early diagnosis and reduction of mortality from breast cancer. Tomosynthesis is coming to further develop the mammography method by providing a solution to the issues arising from the limitations of simple digital mammography”, concludes Mr. Merkouris.