Role of digital breast tomosynthesis and contrast enhanced mammography in characterization of breast masses

Abstract

A mammogram is a breast X-ray that can detect breast masses before they are large enough to feel or cause symptoms (Hubbard et al., 2011),it is the most commonly screening method used for breast masses detection, it helped to reduce mortality of breast cancer patient by 20 percent(Welsh et al.,2014). The limitations of mammography are well known. False – negative results occur when mammograms appear normal even though breast mass is present. Overall, screening mammograms miss up to 20 percent of breast cancers that are present at the time of screening (National cancer institute, 2010). The main problem is that breast masses have the same density as surrounding tissue, and can be obscured by overlapping tissue. With the mass potentially obscured by overlapping tissue in two-dimensional (2-D) conventional mammography, a 3-D procedure, such as tomosynthesis, 2 may help solve this problem. Also, there is hope that the use of intravascular contrast material with digital mammography will take advantage of the mass vascularity to characterize its type. (Alakhras et al.,2013). Digital Breast Tomosynthesis is a relatively new and exciting modality for characterization . Multiple low dose X-ray images are acquired in an arc and reconstructed to form 3D image thus minimizing the impact of overlying breast tissue and improving the lesion conspicuity. The process is similar to a film tomogram and Computed tomography, then post processing allows reconstruction of any slice needed. The radiation dose is the same as a conventional digital dose. The separate slices are 1mm thick resulting in a high resolution. Overlapping shadows and structures are eliminated. The image is displayed as static slices or a cine loop and a regular 2-D image is obtained at the same time. (Rafferty et al., 2013).