One of the primary barriers to women scheduling mammograms is the discomfort – or the fear of the discomfort – from the compression required to remove overlapping tissue for a diagnostic image. Many solutions have been explored to reduce the discomfort or pain in the procedure, including allowing the patient to control the amount of compression used for imaging. In many facilities, this option is not viable as image evaluation provides a range of compression deemed acceptable for diagnostic mammography.
The ideal mammogram would be an exam with no compression, removal of tissue overlaps, rapid acquisition, and available simultaneous assessment of microcalcifications and contrast enhancement. We are seeking the Holy Grail, right?
The quest to find a perfect imaging technique for the breast has been at the center of Mammography for many years. For the past 20+ years, the rate of breast cancers and the pressure to find a perfect imaging technique has occupied clinicians and researchers. Breast MRI has been added to the breast imaging spectrum as an imaging procedure, adding the tissue contrast necessary to image tumors that may not be visible in a standard mammogram. Specialty breast MRI units and breast MRI technologists are not a common alternative for a patient due to the expense of the equipment and training, and the subsequent ability to recapture that expense from procedure CPT codes.
If we review history, we will find that training for DBT mammography began 2012 after the FDA mandated 8 hours of specific training to use the new technology. Over time, DBT units have become the standard imaging technique in screening technology. This imaging technique is complemented with breast ultrasound when a suspicious area is discovered. Patient examination using this standard protocol usually involves the patient making two trips to the department for imaging. And if a FNA is required, a third trip for the biopsy.
The emerging modality of dedicated breast CT has enormous potential for the future of breast imaging. Breast CT shows either noninferiority or superiority with mammography and numerical comparability to MRI after contrast administration. It demonstrates excellent performance in lesion characterization, density assessment, and intervention, and it shows promise for implant patients. Whether it can be used in screening mammography is still unproven.
Even though this is still considered experiential, it has been approved by the FDA, and 6 CPT codes were added in 2022 that relate to breast CT.
Koning is a growing medical device startup company based outside Atlanta. It has a breast CT screening trial underway with participating clinics in Daytona Beach, FL, Rochester, NY, and Knoxville, TN. Koning CEO, Lutao Ning said “A significant time and resource investment will be made towards clinical applications and physician use. After submitting our trial to the FDA for the screening indication, we’ll be able to provide next-generation breast imaging technology to our current and future partner clinics.” Gerald E Grubbs, MD of Sarasota Interventional Radiology, calls the Koning 3D breast imaging machine the most compassionate way to screen for breast cancer. The 3D isotropic breast imaging costs less than a traditional mammogram and is generally covered by insurance.
There is more research and development being done in other types of CT such as phase-contrast breast CT, spectral breast CT, and hybrid imaging.
Breast imaging will continue to use modern technologies to solve the age-old issues coupled to mammography. We will continue to learn more.