Cone-Beam Breast Computed Tomography: Time for a New Paradigm in Breast Imaging

It is time to reconsider how we image the breast. Although the breast is a 3D structure, we have traditionally used 2D mammography to perform screening and diagnostic imaging. Mammography has been continuously modified and improved, most recently with tomosynthesis and contrast mammography, but it is still using modifications of compression 2D mammography. It is time to consider 3D imaging for this 3D structure. Cone-beam breast computed tomography (CBBCT) is a revolutionary modality that will assist in overcoming the limitations of current imaging for dense breast tissue and overlapping structures. It also allows easy administration of contrast material for functional imaging. With a radiation dose on par with diagnostic mammography, rapid 10 s acquisition, no breast compression, and true high-resolution isotropic imaging, CBBCT has the potential to usher in a new era in breast imaging. These advantages could translate into lower morbidity and mortality from breast cancer.

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Dedicated Cone-beam Breast Computed Tomography and Diagnostic Mammography: Comparison of Radiation Dose, Patient Comfort, And Qualitative Review of Imaging Findings in BI-RADS 4 and 5 Lesions

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.93274 ◽

2012 ◽

Vol 2 ◽

pp. 7 ◽

Cited By ~ 33

Author(s):

Avice M. O’Connell ◽

Daniel Kawakyu-O’Connor

Keyword(s):

Computed Tomography ◽

Radiation Dose ◽

Breast Imaging ◽

Qualitative Evaluation ◽

Patient Comfort ◽

Cone Beam ◽

Breast Lesions ◽

Diagnostic Mammography ◽

High Degree ◽

Breast Computed Tomography

Objective: This pilot study was undertaken to compare radiation dose, relative visibility/conspicuity of biopsy-proven lesions, and relative patient comfort in diagnostic mammography and dedicated cone-beam breast computed tomography (CBBCT) in Breast Imaging-Reporting and Data System (BI-RADS)® 4 or 5 lesions. Materials and Methods: Thirty-six consecutive patients (37 breasts) with abnormal mammographic and/or ultrasound categorized as BI-RADS® 4 or 5 lesions were evaluated with CBBCT prior to biopsy. Administered radiation dose was calculated for each modality. Mammograms and CBBCT images were compared side-by-side and lesion visibility/conspicuity was qualitatively scored. Histopathology of lesions was reviewed. Patients were administered a survey for qualitative evaluation of comfort between the two modalities. Results: CBBCT dose was similar to or less than diagnostic mammography, with a mean dose of 9.4 mGy (±3.1 SD) for CBBCT vs. 16.9 mGy (±6.9 SD) for diagnostic mammography in a total of 37 imaged breasts (P<0.001). Thirty-three of 34 mammographic lesions were scored as equally or better visualized in CBBCT relative to diagnostic mammography. Characterization of high-risk lesions was excellent. Patients reported greater comfort in CBBCT imaging relative to mammography. Conclusion: Our experience of side-by-side comparison of CBBCT and diagnostic mammography in BI-RADS® 4 and 5 breast lesions demonstrated a high degree of correlation between the two modalities across a variety of lesion types. Owing to favorable radiation dose profile, excellent visualization of lesions, and qualitative benefits including improved patient comfort, excellent field-of-view, and more anatomical evaluation of lesion margins, CBBCT offers a promising modality for diagnostic evaluation of breast lesions.

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