Elsevier

Clinical Imaging

Volume 37, Issue 2, March–April 2013, Pages 289-294
Clinical Imaging

Original Article
CTLM as an adjunct to mammography in the diagnosis of patients with dense breast

https://doi.org/10.1016/j.clinimag.2012.05.003Get rights and content

Abstract

Purpose

The purpose was to evaluate the utility of computed tomographic laser mammography (CTLM) as an adjunct examination to mammography in women with dense breast tissue.

Methods

We retrospectively compared the findings of mammography, CTLM, and adjunct CTLM to mammography with pathology of 155 women scheduled for biopsy or surgery.

Results

Positive lesions were observed more significantly in malignant than benign lesions. The sensitivity of mammography vs. mammography+CTLM was 34.4% vs. 81.57% among extremely dense breasts and 68.29% vs. 95.34% among heterogeneously dense breasts.

Conclusion

CTLM could distinguish benign lesions from malignant lesions and is not affected by breast density.

Introduction

Early detection and effective treatment of women with a diagnosis of breast cancer are major factors contributing to the decline in the mortality rate. Radiology examination can help in early detection and diagnosis. At the present time, the means of diagnosis of breasts now used include mammography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), near and far infrared, and positron emission tomography (PET)-CT [1]. Mammography is the most widely used; however, conventional screen-film mammography has limited sensitivity for detection of breast cancer especially in breasts with dense tissue. Digital mammography was developed to address some of the limitations of screen-film mammography; however, the value of digital mammography is not substantially different from that of screen-film mammography. Radiology physicians are in need of more functional information.

Tumor “angiogenesis” is known to be critical for the autonomous growth and spread of breast cancers. Tumor angiogenesis is a complex process that involves both the incorporation of existing host blood vessels into the tumor and the creation of tumor microvessels [2]. If these vessels could be found, the information of function can be used by physicians.

The basic principle underlying the new device, computed tomographic laser mammography (CTLM) imaging, is the “angiogenesis.” In the last several years, optical tomography on breast imaging has gained interest all over the world. Light has been investigated since the late 1920s as a diagnostic tool for breast cancer by transillumination; however, it had low spatial resolution and afforded little in spectral quantification of lesions. Hence, it did not attain sufficient sensitivity and specificity to be used clinically. In recent years, optical mammography stepped to new era. Optical introscopy of laboratory animals is extensively developed for studies of DNA and pharmacological preparations. Optical mammography uses either projection or tomographic apparatus. Optical tomographic mammographs are presently available. CTLM (Imaging Diagnosis System Inc., USA) used in our study is now being clinically tested in several countries; the other apparatuses such as Philips OMPS transmission mammography(Optical Mammo Prototype System, Netherlands), SoftScan Optical projection mammography (Advanced Research Technologies Inc., Canada),and ComfortScan mammography (DOBI Medical International Inc., USA) are all being researched [3], [4], [5].

The purpose of the study was to evaluate the utility of computed CTLM as an adjunct examination to mammography in women with heterogeneously dense and extremely dense breast tissue [Breast Imaging Reporting and Data System (BI-RADS)3 and 4].

Section snippets

Patients

From September 2007 to February 2008, 155 women (23–74 years of age; median age: 41years) in Tianjin Medical University Cancer Hospital were scheduled for biopsy or surgery in the short term (within 30 days). All the patients did not undergo current chemotherapy or irradiation of the breast, and were not biopsied within 30 days before the examination. All the patients underwent mammography and CTLM examination before surgery.

According to BI-RADS, all women who underwent mammography were

Mammography

Two radiology physicians reviewed the results and classified all patients into two groups: 74 in heterogeneously dense breast group and 81 in the extremely dense breast group. The impression of mammography is as follows: 48 benign lesions, 15 malignant lesions, and 11 unascertainable lesions in extremely dense breast, and 41 benign lesions, 15 malignant lesions, and 6 unascertainable lesions in heterogeneously dense breast group, as shown in Table 2.

CTLM

Radiology physician recorded CTLM impression,

Discussion

Mammography is the golden standard of breast imaging diagnosis; it has high sensitivity in fatty breast with sharp contrast [6]. Screening mammography and digital mammography are of limited value in dense breasts. In extremely dense and heterogeneously dense breasts, mammography sensitivity is decreased. Mammography sensitivity was 45% to 70% [7]. In our study, in extremely dense breast, the sensitivity of digital mammography was 34.4%, lower than the literature reported. In heterogeneously

References (22)

  • V Corsett et al.

    Role of ultrasonography in detecting mammographically occult breast carcinoma in women with dense breasts

    Radiology

    (2006)

    • Cited by (8)

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