History A 46-year-old Hispanic man with a medical history of diabetes and hepatitis C and an unclear history of prior infectious disease presented to the emergency department of a community medical center in the northeastern United States with a 3-month history of back pain. The patient was originally from Mexico and had been living in the United States for approximately 1 year. Physical examination at the time of admission was noncontributory. Pertinent hematologic laboratory test results were as follows: white blood cell count, 11.2 ×10(9)/L (normal range, [4.5-11.0] ×10(9)/L); neutrophil level, 81.3% (0.81) (normal range, 38.9%-75.1% [0.39-0.75]); hemoglobin level, 7.9 g/dL (normal range, 13.5-18.0 g/dL); hematocrit level, 23.2% (0.23) (normal range, 40.0%-54.0% [0.40-0.54]); and calcium level, 8.3 mg/dL (2.07 mmol/L) (normal range, 8.4-10.4 mg/dL [2.1-2.6 mmol/L]). Protein electrophoresis revealed hypergammaglobulinemia consistent with chronic inflammation. Relevant radiologic studies included computed tomography (CT) and magnetic resonance (MR) imaging of the spine.
After participating in this activity, the radiologist should be better able to identify the principles behind digital breast tomosynthesis, evaluate the advantages and limitations of digital breast tomosynthesis, and discuss how digital breast tomosynthesis, when combined with 2-dimensional mammography, can facilitate breast cancer detection.Breast cancer is the most common form of cancer and the second leading cause of cancer-related death among American women. 1 Women in the United States have a 12% lifetime risk of developing breast cancer and a 3% chance that breast cancer will be the cause of death. 1 Furthermore, it is estimated that in 2013 there will be an incidence of 232,340 new cases of invasive breast cancer, 64,640 cases of carcinoma in situ and 39,620 deaths from breast cancer. 1 Early detection of breast cancer is essential for a good prognostic outcome. Mammographic screening, introduced in the 1980s, has contributed to the decline in breast cancer mortality since 1990. 1
MammographyMammography is a 2-dimensional (2-D) imaging modality that has been shown to decrease breast cancer mortality. 2 However, the sensitivity of mammography is low, ranging between 36% and 70%, and is inversely related to breast tissue density. 3 The poor sensitivity is due partially to the image acquisition technique used in mammography, in which 3-dimensional (3-D) structures are projected onto a 2-D background. 4 In patients with dense breast parenchyma, normal overlapping tissue can obscure lesions or simulate a positive fi nding on 2-D mammography. This can lead to decreased sensitivity and an increased false-positive rate, respectively. 3 The relatively low contrast between tumors and surrounding anatomic structures on mammographic images also contributes to false-negative results. 4 For many patients, this translates into recall for additional imaging, additional radiation exposure, unnecessary biopsies, and increased anxiety.
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