A novel approach to mammographic breast compression: Improved standardization and reduced discomfort by controlling pressure instead of force

Abstract

In a standard 18 daN force-controlled compression protocol, the authors observed an average pressure of 21.3 kPa±54% standard deviation for CC compressions and 14.2 kPa±32% for MLO compressions. Women with smaller breasts endured higher pressures and experienced more pain, as indicated by a significant negative correlation (ρ=-0.19, p<0.01) between contact area and pain score. Multivariate regression showed that contact area is a strong and significant predictor for severe pain (ORNRS≥7 (CC)=0.10/dm2, p<0.05), as is the case with any pain already present before compression (ORNRS≥7 (CC)=1.61 per NRS-point, p<0.05). Model estimations showed that mammographic breast compression with a standardized pressure of 10 kPa, corresponding with normal arterial blood pressure, may significantly reduce the number of severe pain complaints with an average increase in breast thickness of 9% for small breasts and 2% for large breasts. For an average 16.5% thickness difference in prior-current mammogram pairs, the authors found no differences in image quality and AGD CONCLUSIONS: Model estimations and an observer study showed that pressure-controlled mammographic compression protocols may improve standardization and reduce discomfort with limited effects on image quality and AGD.

Ist eine Individualisierung der mammografischen Brustkompression sinnvoll? – Untersuchungen zu Schmerzangaben bei der Mammografie in Bezug auf Kompressionskraft und Fläche der komprimierten Brust

“…If, therefore, the same compressive force were used as the criterion for optimal compression of all breasts, large breasts would tend to be insufficiently compressed, whereas smaller breasts would be subjected to excessive compression. Using the same compression force, higher intramammary pressure is produced in a smaller breast compared to a large breast as a function of the compressed breast surface area [21]. Our results suggest that during breast compression, intramammary pressure as a quotient of compressive force and breast surface area is a better measure of compression tolerance than the patients' pain indication.…”

“…result of the physical extent of compression but rather was influenced by their individual sensitivity to pain [21]. Women with heightened pain sensitivity consequently terminated the compression procedure earlier.…”

“…De Groot et al likewise refer to the significance of intramammary pressure as a parameter for applying individualized compression independent of breast size. Consequently they developed a device for mammography units to continuously display intramammary pressure during compression [20,21]. This allowed standardization of the compression procedure as well as a reduction of compressionrelated pain.…”

Practical Mammography

“…This can lead to a wide variation in applied pressure to the breast -applied pressure is inversely proportional to breast size if the applied compression force is constant 9 . Further information on the use of pressure to optimise breast compression can be found in Chapter 17, Part 4.…”

Technical Note: Validation of two methods to determine contact area between breast and compression paddle in mammography

“…Recent publications point out that controlling pressure can be beneficial in terms of reproducibility, pain, radiation dose, image quality, and detectability of breast cancer. [1][2][3][4][5][6][7][8][9][10][11][12][13] For many years, breast compression has been susceptible to subjectivity and thus large variations in the applied pressure. With mammography systems indicating only the force applied by the paddle, but not the area over which the force is distributed, 14 the exerted pressure (force divided by area) could only be estimated based on subjective cues, such as skin tautness or the patient's perceived pain experience.…”