Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 May;73(5):422-427.
doi: 10.1055/s-0032-1328600.

Full Field Digital Mammography (FFDM) versus CMOS Technology, Specimen Radiography System (SRS) and Tomosynthesis (DBT) - Which System Can Optimise Surgical Therapy?

R Schulz-Wendtland  1 , G Dilbat  2 , M Bani  3 , P A Fasching  3 , K Heusinger  3 , M P Lux  3 , C R Loehberg  3 , B Brehm  1 , M Hammon  1 , M Saake  1 , P Dankerl  1 , S M Jud  3 , C Rauh  3 , C M Bayer  3 , M W Beckmann  3 , M Uder  4 , M Meier-Meitinger  1
Affiliations

Full Field Digital Mammography (FFDM) versus CMOS Technology, Specimen Radiography System (SRS) and Tomosynthesis (DBT) - Which System Can Optimise Surgical Therapy?

R Schulz-Wendtland et al. Geburtshilfe Frauenheilkd. 2013 May.

Abstract
in English, German

Aim: This prospective clinical study aimed to evaluate whether it would be possible to reduce the rate of re-excisions using CMOS technology, a specimen radiography system (SRS) or digital breast tomosynthesis (DBT) compared to a conventional full field digital mammography (FFDM) system. Material and Method: Between 12/2012 and 2/2013 50 patients were diagnosed with invasive breast cancer (BI-RADS™ 5). After histological verification, all patients underwent breast-conserving therapy with intraoperative imaging using 4 different systems and differing magnifications: 1. Inspiration™ (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1 mm, resolution 85 µm pixel pitch, 8 lp/mm; 2. BioVision™ (Bioptics, Tucson, AZ, USA), CMOS technology, photodiode array, flat panel, tungsten source, focus 0.05, resolution 50 µm pixel pitch, 12 lp/mm; 3. the Trident™ specimen radiography system (SRS) (Hologic, Bedford, MA, USA), amorphous selenium, tungsten source, focus 0.05, resolution 70 µm pixel pitch, 7.1 lp/mm; 4. tomosynthesis (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1 mm, resolution 85 µm pixel pitch, 8 lp/mm, angular range 50 degrees, 25 projections, scan time > 20 s, geometry: uniform scanning, reconstruction: filtered back projection. The 600 radiographs were prospectively shown to 3 radiologists. Results: Of the 50 patients with histologically proven breast cancer (BI-RADS™ 6), 39 patients required no further surgical therapy (re-excision) after breast-conserving surgery. A retrospective analysis (n = 11) showed a significant (p < 0.05) increase of sensitivity with the BioVision™, the Trident™ and tomosynthesis compared to the Inspiration™ at a magnification of 1.0 : 2.0 or 1.0 : 1.0 (tomosynthesis) (2.6, 3.3 or 3.6 %), i.e. re-excision would not have been necessary in 2, 3 or 4 patients, respectively, compared to findings obtained with a standard magnification of 1.0 : 1.0. Conclusion: The sensitivity of the BioVision™, the Trident™ and tomosynthesis was significantly (p < 0.05) higher and the rate of re-excisions was reduced compared to FFDM using a conventional detector at a magnification of 2.0 but without zooming.

Ziel: Prospektive Untersuchung, ob mit Hilfe der CMOS-Technologie, dem Specimen Radiography System bzw. der digitalen Brusttomosynthese (DBT) im Vergleich mit einem herkömmlichen FFDM-System eine Senkung der Rate an Reexzisionen möglich ist. Material und Methode: In der Zeit von 12/2012 bis 2/2013 wurde bei 50 Patientinnen ein invasives Mammakarzinom (BI-RADS™ 5) diagnostiziert. Nach histologischer Sicherung erfolgte die brusterhaltende Therapie mit intraoperativem Präparateradiogramm mit 4 unterschiedlichen Systemen und Vergrößerungen: 1. Inspiration™ (Siemens, Erlangen, Deutschland), amorphes Selen, W-Anode, Fokus 0,1 mm, Ortsauflösung 85 µm Pixelpitch, 8 Lp/mm. 2. BioVision™ (Bioptics, Tucson, AZ, USA), CMOS-Technologie, Photodioden Array, Flat Panel, W-Anode, Fokus 0,05, Ortsauflösung 50 µm Pixelpitch, 12 Lp/mm. 3. Trident™ (Hologic, Bedford, MA, USA), Specimen Radiography System (SRS System), amorphes Selen, W-Anode, Fokus 0,05, Ortsauflösung 70 µm Pixelpitch, 7,1 Lp/mm. 4. Tomosynthese (Siemens, Erlangen, Deutschland), amorphes Selen, W-Anode, Fokus 0,1 mm, Ortsauflösung 85 µm Pixelpitch, 8 Lp/mm, Winkelbereich 50 Grad, 25 Projektionen, Scandauer > 20 s, Geometrie: gleichförmige Abtastung, Rekonstruktion: gefilterte Rückprojektion. Die jeweils 600 Präparateradiogramme wurden prospektiv 3 Radiologen auf einem Befundungsmonitor präsentiert. Ergebnisse: Bei den 50 Patientinnen mit histologisch gesichertem Mammakarzinom (BI-RADS™ 6) war bei 39 Patientinnen nach erfolgter brusterhaltender Therapie keine weitere operative Therapie (Reexzision) indiziert. Die retrospektive Analyse (n = 11) ergab eine signifikante (p < 0,05) Steigerung der Sensitivität des BioVision™-, des Trident™-Systems und der Tomosynthese gegenüber dem Inspiration™ bei einer Vergrößerung von 1,0 : 2,0 bzw. 1,0 : 1,0 (Tomosynthese) (2,6, 3,3 bzw. 3,6 %) d. h. eine Reexzision wäre bei 2, 3 bzw. 4 Patientinnen nicht notwendig gewesen im Vergleich zur Standardvergrößerung 1,0 : 1,0. Schlussfolgerung: Sowohl der Einsatz der Präparateradiografie-Systeme BioVision™ und Trident™, aber auch die Tomosynthese zur Präparateradiografie erreichen eine signifikant (p < 0,05) bessere Sensitivität und Reduzierung der Reexzisionsrate im Vergleich zu einem FFDM-System mit herkömmlichem Detektor unter der Voraussetzung einer reellen Vergrößerung mit dem Faktor 2,0, jedoch keinem Zooming.

Keywords: Breast; breast cancer; breast malignancy; mammography.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Specimen radiograph. Inspiration™, magnification 1.0 : 2.0, invasive breast carcinoma pT1cN0M0, diameter 1.6 cm; it is not possible to determine the length of the spicules (arrows) and differentiate them from surrounding tissue.
Fig. 2
Fig. 2
BioVision™ and Trident™: magnification 1.0 : 2,0, invasive breast carcinoma pT1cN0M0, diameter 1.6 cm; the spicules (arrows) are clearly visible and easily differentiated from the surrounding tissue. Identical images were created when both systems (BioVision™ and Trident™) were used under the same assessment conditions (expansion of the publication by Schulz-Wendtland R et al. Geburtsh Frauenheilk 2012; 72: 532–538).
Fig. 3
Fig. 3
Tomosynthesis, image 7 of 25; magnification 1.0 × 1.0, invasive breast carcinoma pT1cN0M0, diameter 1.6 cm; the spicules (arrows) were clearly visible and could be differentiated well from the surrounding tissue (using imaging and confirmed by histological investigation). The guide wire was removed in Figs. 1 to 3 to show how the differentiation of the tumor from the surrounding tissue.
See this image and copyright information in PMC

References

    1. Ruckhaberle E, Solbach C, Kaufmann M. Conference report on the 31th annual San Antonio breast cancer symposium, December 10–14, 2008 “Continuing change in diagnostics and therapy of breast cancers – from molecular basics to tailored therapy”. Geburtsh Frauenheilk. 2009;69:202–211.
    1. Kaufmann M, Rody A. Breast cancer: reduced mortality by early detection and adjuvant therapy. Geburtsh Frauenheilk. 2009;69:218–232.
    1. Katalinic A. Breast cancer: declining mortality despite its increasing incidence. Geburtsh Frauenheilk. 2009;69:237–239.
    1. Beckmann M W, Blohmer J U, Costa S D. et al.Zurich consensus: German expert opinion on the St. Gallen votes on 15 March 2009 (11th international conference at St. Gallen: primary therapy of early breast cancer) Geburtsh Frauenheilk. 2009;69:377–383. - PMC - PubMed
    1. Ruckhaberle E, Rody A, Kaufmann M. Report of the 32nd annual St. Antonio breast cancer symposium, December 10–13, 2009 “An international scientific symposium for interaction and exchange among basic scientists and clinicians in breast cancer”. Geburtsh Frauenheilk. 2010;70:177–183.