3-D mammography (also known as breast tomosynthesis) is the most significant advancement in breast imaging to occur in the last 25 years
As each of us has moved into the digital age, whether we embrace it or not, medicine and so many other areas of our lives have undergone dramatic changes. Many of these changes are improving our lives. In the world of medical imaging, the invention of 3-D mammography (also known as breast tomosynthesis) is the most significant advancement in breast imaging to occur in the last 25 years. The use of digital mammography in the 90’s was a step forward but it mostly improved the lives of the people who worked in the medical industry. However, digital mammography paved the way for 3-D mammography (3-Dm), which is a giant leap forward for the patient, not just their care providers.
With 3-Dm, the mammogram machine creates a series of pictures 1-2mm in thickness from the top to the bottom of the breast and from the inside edge to the outside edge. This information can be fused into a 2-D image (much like a conventional mammogram), or each individual 1-2mm slice can be viewed in the same way you would flip through the pages of a good or e-reader. This allows the radiologist to see inside the breast and to be able to avoid structures in the breast that might be in the way of a lesion. Another way to picture the benefit of 3-Dm is to compare it to a bowl of M&Ms. If you had 100 brown M&Ms and one pink M&M in clear bowl, would you be able to see the pink one? Well, sometimes you would and sometimes you wouldn’t. But if you could cut the bowl up into ten slices and pick each slice up to look at it, you would find the pink one almost every time. This is why 3-Dm finds 30-40% more breast cancers than regular 2-D mammograms. It also explains why the patient is called back for additional imaging far less frequently that with regular mammograms. Patient recalls for additional images decrease by 30-40% when compared to conventional mammography. The patient will hardly notice any difference between her 3-Dm and her old 2-D mammogram. The patient will still be put into the same two positions for the same amount of time. Sorry about that ladies!
So, you may be asking, “Is all this hoopla associated with 3-D mammography really worth it? The best way to answer this is by showing how 3-Dm affected a real patient. The first breast cancer I diagnosed at our Hilton Head office was on “Judy”. Judy was a nurse in her 50’s, who came to our office with a lump she could feel. It has been there for a good deal of time and she had a previous conventional mammogram that showed some dense tissue in the area but nothing that looked like cancer. She also had a prior ultrasound of this area which did not show anything that looked like cancer. When she came to see us, she was perplexed, wondering why she could feel this lump but no one could find anything. We wondered the same thing. While most masses that women feel in their breasts are benign (cysts, fibroadenomas, etc.), doctors must consider these masses suspicious until proven otherwise.
When we performed the 3-Dm, the first images I reviewed were in 2-D and they showed very dense breast tissue in the area where she felt the lump, but nothing that looked like cancer. But when I began to scroll through the 3-D images, it quickly became apparent that something wasn’t right. The area that looked like only dense tissue on the 2-D image showed small finger-like projections around the edges when seen in 3-D. These “fingers” represent the body’s reaction to something that is invading normal tissue. When this occurs in the breast, the diagnosis is usually cancer. I talked to Judy about the findings and we agreed that the mass needed tissue sampling, also called a biopsy. We performed the biopsy the next day and waited for the results.
While I really like what I do for a living, the thing I had to do next is my least favorite part of the job. Some people want to hear it in person, and for others a phone call will do. I called Judy and told her she had breast cancer. It didn’t come as a surprise to either of us. While she did not want the diagnosis of cancer and I certainly did not want to provide that diagnosis, the technology of 3-D mammography did allow me to finally give her a diagnosis for the lump she had been feeling. She has since had surgery, radiation, and chemotherapy and we will be seeing her soon for her follow-up mammograms.
While digital technology has enabled imaging advances like 3- Dm, the real advancement is in how this improves the lives of real people. We all know someone or know of someone who has been diagnosed with breast cancer and we have all heard of the tremendous struggle that they go through. These patients touch the lives of caregivers, such as myself, more than they will ever know.
In Judy’s case, 3-Dm showed us things we wouldn’t have otherwise seen. Finding breast cancer early, using every tool we have is the least I can do for my patients.