Nachweis von Mikrokalk mittels cone-beam Computertomographie (CBCT) der weiblichen Brust im Vergleich zum Standardverfahren der digitalen Mammographie
von Viktorija Andrijevska
Datum der mündl. Prüfung:2023-11-07
Betreuer:PD Dr. Susanne Wienbeck
Gutachter:PD Dr. Gerd-Johannes Bauerschmitz
Gutachter:Prof. Dr. Ralf Dressel
EnglischDigital MG is still used as the primary examination procedure in the context of breast diagnostics, but it has significant limitations, especially in women with high breast density. In addition to the detection of breast tumors, which usually show up as focal findings in MG, the imaging of microcalcification is considered an important requirement for early detection procedures. Better early detection methods are intended to improve diagnostics and reduce the number of unnecessary surgical and biopsy interventions in women with breast cancer and precancerous lesions, the DCIS. Dedicated CBCT is a novel imaging technique for the uncompressed breast using X-rays. During the examination, the patient is positioned in the prone position and the breast is stored in its natural form in the gantry. The absence of compression is intended to enable a more precise anatomical assignment of findings and to improve the planning of breast-conserving surgical procedures. After the examination (10 – 15 sec per breast), a three-dimensional reconstruction of the breast is performed. Any new method in breast imaging must compare its diagnostic performance with the current gold standard of digital MG. For the detection and evaluation of focal findings, the superiority of CBCT has been shown in studies. For the current few data for the assessment of microcalcification in the breast, this study provides complementary results and first results in a blinded multi-reader study. For this purpose, 90 breasts were examined using digital MG in 2 planes and CBCT and the radiological image material obtained was evaluated with regard to calcifications in the breast. Overall, significantly more microcalcification areas were seen in the MG than in the CBCT. However, the specificity of both methods did not differ significantly. Intrarater reliability was good for both methods. Interrater reliability was moderate in the CBCT, as a possible indication of the need for adequate familiarization with this new method. Unlike in MG, breast density has no effect on the sensitivity and specificity of CBCT. The sensitivity of MG for the detection and assessment of microcalcification is superior to CBCT even in women with dense glandular tissue. CBCT is currently a complementary imaging method in breast diagnostics. The absence of the breast compression required for MG offers advantages for the patient. However, the currently obtained moderate clinical results for the detection of microcalcification by CBCT do not currently justify the abandonment of MG as an imaging procedure. A conceivable replacement of the digital MG by the CBCT will depend crucially on the extent to which technical improvements in the spatial resolution of breast CT are able to represent breast cancer precursors in addition to the detection of breast cancer. Only then can a possible use of the procedure in the context of primary breast diagnostics be discussed.
Keywords: breast microcalcification