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. 2017 Nov 28;19(1):126.
doi: 10.1186/s13058-017-0917-3.

Influence of breast compression pressure on the performance of population-based mammography screening

Katharina Holland  1 , Ioannis Sechopoulos  2 , Ritse M Mann  2 , Gerard J den Heeten  3 , Carla H van Gils  4 , Nico Karssemeijer  2
Affiliations

Influence of breast compression pressure on the performance of population-based mammography screening

Katharina Holland et al. Breast Cancer Res. .

Abstract

Background: In mammography, breast compression is applied to reduce the thickness of the breast. While it is widely accepted that firm breast compression is needed to ensure acceptable image quality, guidelines remain vague about how much compression should be applied during mammogram acquisition. A quantitative parameter indicating the desirable amount of compression is not available. Consequently, little is known about the relationship between the amount of breast compression and breast cancer detectability. The purpose of this study is to determine the effect of breast compression pressure in mammography on breast cancer screening outcomes.

Methods: We used digital image analysis methods to determine breast volume, percent dense volume, and pressure from 132,776 examinations of 57,179 women participating in the Dutch population-based biennial breast cancer screening program. Pressure was estimated by dividing the compression force by the area of the contact surface between breast and compression paddle. The data was subdivided into quintiles of pressure and the number of screen-detected cancers, interval cancers, false positives, and true negatives were determined for each group. Generalized estimating equations were used to account for correlation between examinations of the same woman and for the effect of breast density and volume when estimating sensitivity, specificity, and other performance measures. Sensitivity was computed using interval cancers occurring between two screening rounds and using interval cancers within 12 months after screening. Pair-wise testing for significant differences was performed.

Results: Percent dense volume increased with increasing pressure, while breast volume decreased. Sensitivity in quintiles with increasing pressure was 82.0%, 77.1%, 79.8%, 71.1%, and 70.8%. Sensitivity based on interval cancers within 12 months was significantly lower in the highest pressure quintile compared to the third (84.3% vs 93.9%, p = 0.034). Specificity was lower in the lowest pressure quintile (98.0%) compared to the second, third, and fourth group (98.5%, p < 0.005). Specificity of the fifth quintile was 98.4%.

Conclusion: Results suggest that if too much pressure is applied during mammography this may reduce sensitivity. In contrast, if pressure is low this may decrease specificity.

Keywords: Breast cancer screening; Breast compression; Mammography; Performance measures.

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Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was not required for this study as women automatically consent to the use of their anonymized data for scientific purposes by participating in screening unless they object. A waiver from the research ethics committee of the Radboud University Medical Center was obtained to use the anonymized images.

Consent for publication

Not applicable.

Competing interests

IS has a research agreement and speaking agreement with Siemens AG, and a research agreement with Toshiba Medical Systems Corporation. RMM has a research agreement with Siemens AG, Seno Medical Instruments Inc., and Identification solutions Inc. GJdH is a founder and employee of Sigmascreening. CHvG reports non-financial support from Volpara Health Technologies outside the submitted work. NK is a shareholder and consultant to Volpara Health Technologies, a director and shareholder of ScreenPoint Medical, and a shareholder and consultant to Qview Medical. KH declares that she has no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Measurements of force and pressure in relation to the breast volume. The color code represents the number of examinations in each bin. The horizontal lines in the right panel indicate the thresholds used to obtain the five pressure groups and the minimum and maximum pressure value observed
Fig. 2
Fig. 2
Measurements of 12-month sensitivity and specificity. Measurements of 12-month sensitivity and specificity of the five pressure groups of unadjusted data (squares) and after adjustment with generalized estimating equations (GEE) for multiple screening rounds, breast volume, and percent dense volume including 95% CI (circles). Statistically significant differences between pairs of groups of the GEE adjusted data are indicated
See this image and copyright information in PMC

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