2023-11-08 11:58:35
Many women have dense breasts, when fibro-glandular tissue is abundant, which in itself represents a risk of breast cancer, but also because it makes it difficult to see any suspicious lump. On World Radiology Day, we delve into imaging techniques that help detect anomalies in cases of breast density and with an eye toward artificial intelligence.
Dr. Alejandro Tejerina, radiologist and director of the Diagnostic Imaging Area of the Breast Pathology Center-Tejerina Foundation. Photo provided
Dense breast is present in approximately 50% of mammography studies of patients of population screening age in Spain, between 50 and 69 years, so it is a “common situation” in women and clinical practice, explains to EFEsalud the Dr. Alejandro Tejerina, director of the Diagnostic Imaging Area of the Breast Pathology Center-Tejerina Foundation.
The breast is made up of fat and fibro-glandular tissue and is considered breast density when there is a greater proportion of this type of tissue.
In general, dense breast is greater in young patients and decreases with age.
The visual estimation of the breast establishes four levels of density:
A. The breasts are completely fatty.
B. There are scattered areas of fibro-glandular tissue.
C. The breasts are heterogeneously dense, which can hide small masses.
D. The breasts are extremely dense, which decreases the sensitivity of mammography.
This is explained in the book “Medical Imaging in Breast Pathology”a collaboration between the Complutense University and the Tejerina Foundation, which has the purpose of disseminating updated knowledge on the diagnosis of various breast pathologies, especially aimed at health professionals.
Non-dense breasts and dense breasts. Image provided by the Tejerina Foundation
The distribution of these categories in the population of screening age is approximately 10% with A; 40 % con B; 40 % con C and 10% with D. So C and D are considered dense breast.
Dense breast and cancer risk
One of the chapters of the book is especially dedicated to breast density, a common aspect in women, but no less important.
Dense breast is a risk factor for breast cancer on its own, but it is also necessary to put it in the context of other factors such as age, family history of cancer, having had early menstruation or late menopause, among others. .
“A woman who has a high dense breast, a category Dhas approximately 4 to 6 times the risk of breast cancer than someone with fatty breasts, a category A“, indicates radiologist Alejandro Tejerina.
From mammography to MRI
The conventional mammography It reflects fibro-glandular tissue with whiter or brighter areas, while fat appears darker.
In most public health centers, conventional mammograms are performed as part of the screening program, although many already incorporate mammography with tomosynthesis.
Dr. Tejerina explains that mammography with tomosynthesis is a more advanced technique, in 3D, that increases detection and reduces both false negatives, that is, when the malignant lesion is not seen, and false positives.
The dense breast is greater in young women. Image provided by the Tejerina Foundation.
But to delve into the study of this dense breast, with fibro-glandular tissue that can represent a risk in itself or mask lumps or masses, experts recommend a complementary test that rules out anomalies, such as a breast ultrasound in asymptomatic patients.
Now, the magnetic resonancewith high sensitivity, is used in patients with malignant lesions and in patients who have a risk profile (such as having a family history of breast cancer or genetic mutations, such as BRCA) and its use is contemplated in extremely dense breasts such as confirmation test.
An alternative to MRI is contrast mammography which has the advantage of being a shorter and more accessible test.
Artificial intelligence, now a reality
“It is already a reality” the existence of both artificial intelligence programs that measure the amount of breast density, as well as others that work in the detection of breast cancer, says the radiologist of the Tejerina Foundation.
The latter read the mammogram and offer probabilities of a low or high suspicious finding.
Readings that bring the experience and interpretation of the radiology professional face to face with technology: “What has been seen, in many studies, is that the combined reading systems, that of the radiologist and that of the artificial intelligence system, increase “global detection” of breast cancer, says the specialist.
Artificial intelligence that Dr. Alejandro Tejerina considers an “opportunity” to continue advancing in knowledge about the breast and to stop the possible risks of cancer.
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