Performance of Breast Cancer Screening Depends on Mammographic Compression

  • Katharina Holland
  • Ioannis Sechopoulos
  • Gerard den Heeten
  • Ritse M. Mann
  • Nico Karssemeijer
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 9699)

Abstract

During mammographic acquisition, the breast is compressed between the breast support plate and the compression paddle to improve image quality and reduce dose, among other reasons. The applied force, which is measured by the imaging device, varies substantially, due to local guidelines, positioning, and breast size. Force measurements may not be very relevant though, because the amount of compression will be related to pressure rather than force. With modern image analysis techniques, the contact surface of the breast under compression can be determined and pressure can be computed retrospectively. In this study, we investigate if there is a relation between pressure applied to the breast during compression and screening performance.

In a series of 113,464 screening exams from the Dutch breast cancer screening program we computed the compression pressure applied in the MLO projections of the right and left breasts. The exams were binned into five groups of increasing applied pressure, in such a way that each group contains 20 % of the exams. Thresholds were 7.68, 9.18, 10.71 and 12.81 kPa. Screening performance measures were determined for each group. Differences across the groups were investigated with a Pearson’s Chi Square test.

It was found that PPV and the cancer detection rate vary significantly within the five groups (p = 0.001 and p = 0.011 respectively). The PPV was 25.4, 31.2, 32.7, 25.8 and 22.0 for the five groups with increasing pressure. The recall rate, false positive rate and specificity were not statistically significant from the expectation (p-values: 0.858, 0.088 and 0.094 respectively). Even though differences are not significant, there is a trend that the groups with a moderate pressure have a better performance compared to the first and last category.

The results suggest that high pressure reduces detectability of breast cancer. The best screening results were found in the groups with a moderate pressure.

Keywords

Digital mammography Screening Performance Pressure 

References

  1. 1.
    Chen, B., Wang, Y., Sun, X., Guo, W., Zhao, M., Cui, G., Hu, L., Li, P., Ren, Y., Feng, J., Yu, J.: Analysis of patient dose in full field digital mammography. Eur. J. Radiol. 81(5), 868–872 (2012)CrossRefGoogle Scholar
  2. 2.
    Heine, J.J., Cao, K., Thomas, J.A.: Effective radiation attenuation calibration for breast density: compression thickness influences and correction. Biomed. Eng. Online 9, 73 (2010)CrossRefGoogle Scholar
  3. 3.
    Kopans, D.B.: Breast Imaging, 3rd edn. Lippincott Williams & Wilkins (2007)Google Scholar
  4. 4.
    Saunders Jr., R.S., Samei, E.: The effect of breast compression on mass conspicuity in digital mammography. Med. Phys. 35(10), 4464–4473 (2008)CrossRefGoogle Scholar
  5. 5.
    Dullum, J.R., Lewis, E.C., Mayer, J.A.: Rates and correlates of discomfort associated with mammography. Radiology 214(2), 547–552 (2000)CrossRefGoogle Scholar
  6. 6.
    Keefe, F.J., Hauck, E.R., Egert, J., Rimer, B., Kornguth, P.: Mammography pain and discomfort: a cognitive-behavioral perspective. Pain 56(3), 247–260 (1994)CrossRefGoogle Scholar
  7. 7.
    Perry, N., Broeders, M., de Wolf, C., Törnberg, S., Holland, R., Karsa, L.V.: European Guidelines for Quality Assurance in Breast Cancer Screeningand Diagnosis, 4 edn. (2008)Google Scholar
  8. 8.
    de Groot, J.E., Broeders, M.J.M., Branderhorst, W., den Heeten, G.J., Grimbergen, C.A.: A novel approach to mammographic breast compression: Improved standardization and reduced discomfort by controlling pressure instead of force. Med. Phys. 40(8), 081901 (2013)CrossRefGoogle Scholar
  9. 9.
    Branderhorst, W., de Groot, J.E., Highnam, R., Chan, A., Böhm-Vélez, M., Broeders, M.J.M., den Heeten, G.J., Grimbergen, C.A.: Mammographic compression-a need for mechanical standardization. Eur. J. Radiol. 84(4), 596–602 (2015)CrossRefGoogle Scholar
  10. 10.
    Mercer, C.E., Hogg, P., Lawson, R., Diffey, J., Denton, E.R.E.: Practitioner compression force variability in mammography: a preliminary study. Br. J. Radiol. 86(1022), 20110596 (2013)CrossRefGoogle Scholar
  11. 11.
    de Groot, J.E., Branderhorst, W., Grimbergen, C.A., den Heeten, G.J., Broeders, M.J.M.: Towards personalized compression in mammography: a comparison study between pressure- and force-standardization. Eur. J. Radiol. 84(3), 384–391 (2015)CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Katharina Holland
    • 1
  • Ioannis Sechopoulos
    • 1
  • Gerard den Heeten
    • 2
  • Ritse M. Mann
    • 1
  • Nico Karssemeijer
    • 1
  1. 1.Radboud University Medical CenterNijmegenThe Netherlands
  2. 2.Academic Medical Center AmsterdamAmsterdamThe Netherlands

Personalised recommendations