KCBC’S POSITION ON “3D” MAMMOGRAPHY (TOMOSYNTHESIS)
There is a lot of buzz today in the mammography field about “3D” mammography being more sensitive in detecting breast cancers in dense breasts than the traditional “2D” mammography. At KCBC we receive a lot of questions about this newer technique and why KCBC does not perform “3D” mammography.
First, describing “3D” mammography as such is a misnomer. For it to be truly a 3D technique such as with MRI and CT scanning, the structure being imaged has to be seen in multiple slices from front to back (coronal), side to side (sagittal), and from top to bottom (cranial caudal) views.
“3D” mammography can only image multiple slices from side to side (sagittal) and top to bottom (cranial caudal).
Since 1983 when KCBC opened its doors and saw its first patients, this practice has performed 2D mammography along with breast ultrasound screening for women with dense breasts long before ultrasound was recognized as a valuable adjunct imaging modality to mammography. It was only truly recognized in early 2000.
It is so important to evaluate the dense mammographic pattern with ultrasound in addition to mammography. Ultrasound evaluates the breast tissues differently –sound absorption of tissues which creates images that demonstrate anatomy of the breast. The entire breast is imaged from the skin down to the chest wall. There is no overlapping of tissue which still occurs with “3D” mammography. With breast ultrasound, we can also evaluate the vascularity of questionable findings as well as the stiffness of the questioned findings, which results in additional value of breast ultrasound in the diagnosis of breast abnormalities.
A controlled clinical trial in a large series of patients was presented at the European Breast Cancer Conference in 2016 that compared the sensitivity of “3D” mammography versus 2D mammography and breast ultrasound. The results of the study showed that 2D mammography and breast ultrasound found more cancers than “3D” mammography.
The other statement one hears with “3D” mammography is that there are less callbacks for indeterminate findings. In fact, the callbacks were similar in both techniques utilized. So, one must ask the question, how many cancers is “3D mammography” missing?
At KCBC, we have seen women for second opinions where the “3D” mammography missed cancers involving half of the breast as well as small cancers that were seen in with 2D mammography and breast ultrasound.
Keep in mind, the KCBC Clinical Breast Radiologists are like the European breast radiologists who are recognized as mastologists in Europe. Mastologists are dedicated clinical breast imagers, which is a recognized subspecialty of radiology in Europe. Unfortunately, this subspecialty is not recognized in the U.S. Women and many physicians do not know this important fact. Most radiologists in the U.S. that read mammograms are not dedicated breast radiologists. In fact, most radiologists read multiple imaging modalities for multiple parts of the body and rotate with the other radiologists in their practice to read mammogram images. At KCBC, we specialize in, and are dedicated to treating breast cancer, and therefore read ONLY imaging related to the breast.