Luis Pina Insausti. PHOTO: Manuel Castells

The Clínica Universidad de Navarra has incorporated digital mammography with tomosynthesis -a technique that offers the image of the breast in different planes- to the usual mammographic programs of study in cases of dense breasts. The purpose of adding this new imaging study responds to the need to provide more information to conventional digital mammography in the examination of this subject of breasts, typical of the female population between 45 and 55 years of age.

According to Dr. Luis Pina Insausti, specialist in Radiology of the Breast Pathology area of the Clínica Universidad de Navarra, "with conventional digital mammography we obtain a two-dimensional image of the breast. Although it is effective in programs of study fatty breasts, in dense breasts -with a large amount of fibrosis- the superimposition of planes could hide a lesion or induce suspicion in cases in which there is no alteration whatsoever".

Tomosynthesis and mammography on the same equipment

The tomosynthesis technology has been incorporated by installing specific hardware and software on the same digital mammography equipment already available at the Clinic. In this way, the device offers the mammography images and, by means of a second scan, the specific images of a tomograph. This new technology provides a segmentation of the image of the breast in 25 slices, which allows its recreation in three dimensions (3D), obtaining greater diagnostic accuracy.

Thus, the newly incorporated tomographic study offers the image dissected in planes. "The benefits it provides lie in the elimination of tissue overlapping, which caused us problems of false positives, as well as the concealment of existing lesions," the specialist explains. "In this way, we are able to advance in a more accurate diagnosis for this breast subject ," he adds.

Until now, the Breast Pathology area of the Clinic resolved these possible doubts with the additional performance of a breast ultrasound. "With the complementary ultrasound programs of study , the diagnostic results we had obtained up to now were good," says the radiologist. Even so," he adds, "we saw a proportion of mammograms of dense breasts in which the aforementioned limitations of overlapping planes and, therefore, possible concealment of lesions occurred."

It should be noted that in fatty subject breasts, which represent the largest proportion of those examined in screening campaigns for the prevention of breast cancer, examination by conventional digital mammography is very effective, so that in these cases the tomosynthesis programs of study would be unnecessary. For this reason, the new technique will be applied only in those patients in whom it can be beneficial.

procedure and comparative study

Since the incorporation of tomosynthesis into the digital mammograph, the usual procedure in the Clinic for preventive mammographic programs of study begins with the performance of a conventional mammogram. "In view of the image obtained from the mammogram, the need for tomosynthesis is assessed. In those cases in which it is necessary, we also continue to perform an ultrasound scan," says Dr. Pina.

In this way, the radiologists in the area of Breast Pathology simultaneously carry out a comparative study of the benefits of both complementary techniques - tomosynthesis and ultrasound - in the study of the breast. According to the specialist, "these are two imaging programs of study that offer totally different information, one obtained by X tomosynthesis) and the other by ultrasound (ultrasound)".

However, Dr. Pina stresses that the standard procedure established and internationally recognized is conventional mammography. The rest of the techniques "are complements aimed at improving the image and information obtained by mammography". The first results of the comparative study between tomosynthesis and ultrasound are expected within a year, by which time the Clinic expects to have studied nearly 5,000 cases.