Mammography and digital breast tomosynthesis


In addition to the clinical examination of the female breast, X-ray mammography is the basic diagnostic means to detect breast diseases. Mammography is a conventional X-ray examination of the female breast. Because breast tissue only has minor differences in density, a less intense radiation is necessary than in X-ray examinations, e.g., of the lung or bones. This is achieved by a special X-ray tube.

The less intense radiation allows us to differentiate between tissue that only slightly differs in density, e.g., glandular tissue, fat and pathological changes.

When is mammography indicated?

Mammography is used for the early detection of breast cancer, which is one of the worst threats to women. It is the most common cancer and cause of death of women at the age of 40 to 60. The last decades have proven that periodic mammography significantly increases the chances of early detecting breast cancer as well as the chances to survive and conserving the breast.

With mammography, physicians are even able to detect carcinoma that could not be found during a manual check but that have an excellent chance of being cured. Furthermore, mammography serves as an evaluative tool of lumps/pathological changes found in the manual check and as a surveillance tool of high-risk patients. It is used as basic diagnostic procedure, which can be complemented, in case of specific question or ambiguous findings, by breast ultrasound and MR mammography.

How is mammography carried out?

In order to get an even depiction of the whole female breast, the breast has to be compressed between two panels of acrylic glass. This is, although painful, an inevitable step of mammography because the compression improves the early detection of breast cancer and leads to a reduced radiation exposure.

Digital breast tomosynthesis

A special type of mammography is the so-called digital breast tomosynthesis, which is a three-dimensional mammography.

Digital breast tomosynthesis is an advanced variation of the digital mammography that creates three-dimensional images of the breast. This innovative procedure works with an X-ray tube that takes images in an arch-like movement of the breast from various angles and resolves with millimeter accuracy. The radiation exposure is comparable to conventional mammography.

The three-dimensional digital breast tomosynthesis is an alternative to the two-dimensional mammography and is used in breast cancer diagnostics.

When is digital breast tomosynthesis indicated?

The risk of a breast disease increases with age. A genetic predisposition/breast disease in the family history also makes it more likely to get breast cancer. Beyond the national mammography screening program, mammography/digital breast tomosynthesis is indicated in the following cases:

  • conspicuous findings during a manual examination of the breast
  • pathologically enlarged lymph nodes in the armpits
  • known genetic predisposition/breast disease in family history
  • new, especially one-sided pain of the breast

How often mammography examinations are necessary, depends on the individual patient. Thus, the personal consultation with a general practitioner or gynecologist is the first step in diagnostics.

Digital breast tomosynthesis is especially valuable in the evaluation of very thick breast tissue.

How is digital breast tomosynthesis carried out?

Please refrain from any cream, lotion or deodorant on breast and armpits because it can affect the image quality. Digital breast tomosynthesis takes place while standing. It is harmless and very quick. In order to get optimal image quality, the breasts have to be compressed, which may be uncomfortable. Since the duration of the examination is very short, this pressure is quite tolerable.

Digital breast tomosynthesis in comparison to mammagraphy

With digital breast tomosynthesis, we are able to visualize structures of the breast without any image overlapping. This increases the diagnostic clarity in comparison to digital mammography. Furthermore, tomosynthesis can show very small changes of breast tissue so that some biopsies are not necessary anymore.