Cone-Beam Breast Computed Tomography: Time for a New Paradigm in Breast Imaging

Abstract

It is time to reconsider how we image the breast. Although the breast is a 3D structure, we have traditionally used 2D mammography to perform screening and diagnostic imaging. Mammography has been continuously modified and improved, most recently with tomosynthesis and contrast mammography, but it is still using modifications of compression 2D mammography. It is time to consider 3D imaging for this 3D structure. Cone-beam breast computed tomography (CBBCT) is a revolutionary modality that will assist in overcoming the limitations of current imaging for dense breast tissue and overlapping structures. It also allows easy administration of contrast material for functional imaging. With a radiation dose on par with diagnostic mammography, rapid 10 s acquisition, no breast compression, and true high-resolution isotropic imaging, CBBCT has the potential to usher in a new era in breast imaging. These advantages could translate into lower morbidity and mortality from breast cancer.

Comparison of malignant calcification identification between breast cone-beam computed tomography and digital mammography

“…Breast CBCT is a 3D imaging modality that images the entire breast with isotropic resolution and without compression, distortion, or overlapping (23,24). With the development of its clinical application, it is necessary to further clarify the characteristics of lesions on CBCT images.…”

Accuracy of cone-beam computed tomography, digital mammography and digital breast tomosynthesis for microcalcifications and margins to microcalcifications in breast specimens

“…Regarding the latest promising studies with further improved breast CT imaging technology for specimens 32 , 33 as well as for breast imaging, which might even be additionally improved by contrast media application 25 , more focus should be laid on breast CT. Especially in preoperative imaging dedicated breast CT might be a promising alternative to the more expensive breast MRI.…”

“…However, due to a limited scan angle DBT cannot produce isotropic imaging data. In contrast, CBCT is a fully three-dimensional imaging technique without breast compression, which allows reconstructions with isotropic voxels and a high spatial resolution that even enables the visualization of microcalcifications to different extents, unlike conventional computed tomography 23 – 25 . In addition, in other studies dedicated breast CBCT dose proved to be similar to or even less than DM dose 26 .…”

No sonographer, no radiologist: Assessing accuracy of artificial intelligence on breast ultrasound volume sweep imaging scans

“…In contradistinction to screening mammography which is performed on asymptomatic patients, ultrasound is typically used as a diagnostic technique to evaluate a patient presenting with a symptom, such as a palpable lump. Ultrasound and mammography are complementary imaging modalities each with their own strengths and weaknesses [ 11 ]. Since screening is often not available in LMICs, most patients with cancer will present with a palpable lump which is amenable to examination with ultrasonography [ 12 ].…”