Compression forces used in the Norwegian Breast Cancer Screening Program

Waade, Gunvor G.; Moshina, Nataliia; Sebuødegård, Sofie; Hogg, Peter; Hofvind, Solveig

doi:10.1259/bjr.20160770

Cited by 25 publications

(21 citation statements)

References 25 publications

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“…However, there are no quantitative guidelines regarding the compression force a radiographer should apply for acquisition of an adequate mammogram. In practice, compression force in mammography varies widely among radiographers, screening centers, and countries [ 5 – 10 ]. A disadvantage of compression is that many women complain about discomfort and pain which might influence their participation in screening [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of breast compression pressure on the performance of population-based mammography screening

et al. 2017

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BackgroundIn mammography, breast compression is applied to reduce the thickness of the breast. While it is widely accepted that firm breast compression is needed to ensure acceptable image quality, guidelines remain vague about how much compression should be applied during mammogram acquisition. A quantitative parameter indicating the desirable amount of compression is not available. Consequently, little is known about the relationship between the amount of breast compression and breast cancer detectability. The purpose of this study is to determine the effect of breast compression pressure in mammography on breast cancer screening outcomes.MethodsWe used digital image analysis methods to determine breast volume, percent dense volume, and pressure from 132,776 examinations of 57,179 women participating in the Dutch population-based biennial breast cancer screening program. Pressure was estimated by dividing the compression force by the area of the contact surface between breast and compression paddle. The data was subdivided into quintiles of pressure and the number of screen-detected cancers, interval cancers, false positives, and true negatives were determined for each group. Generalized estimating equations were used to account for correlation between examinations of the same woman and for the effect of breast density and volume when estimating sensitivity, specificity, and other performance measures. Sensitivity was computed using interval cancers occurring between two screening rounds and using interval cancers within 12 months after screening. Pair-wise testing for significant differences was performed.ResultsPercent dense volume increased with increasing pressure, while breast volume decreased. Sensitivity in quintiles with increasing pressure was 82.0%, 77.1%, 79.8%, 71.1%, and 70.8%. Sensitivity based on interval cancers within 12 months was significantly lower in the highest pressure quintile compared to the third (84.3% vs 93.9%, p = 0.034). Specificity was lower in the lowest pressure quintile (98.0%) compared to the second, third, and fourth group (98.5%, p < 0.005). Specificity of the fifth quintile was 98.4%.ConclusionResults suggest that if too much pressure is applied during mammography this may reduce sensitivity. In contrast, if pressure is low this may decrease specificity.

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Section: Introductionmentioning

confidence: 99%

Influence of breast compression pressure on the performance of population-based mammography screening

et al. 2017

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“…Studies on women's preferences and/or experience of pain and discomfort at mammography have never been performed in Norway. The compression force used has been shown to vary between breast centers, mammography systems and radiographers (151), which suggests that confounding may be present in the form of the radiographer's preferences and site-specific compression force. It is possible that the radiographers' preference to use a compression force above the average for women with small breasts and high stiffness, who will presumably have high mammographic density (152).…”

Section: Confoundingmentioning

confidence: 99%

“…It is possible that the radiographers' preference to use a compression force above the average for women with small breasts and high stiffness, who will presumably have high mammographic density (152). The recommendations of the quality assurance manual regarding application of compression force ranging from 108 to 177 N have been shown to be followed in approximately 60% of acquired mammograms (151,183). Because a large proportion of mammograms are acquired using compression force outside of the recommended limits, it is possible that the observed effects in Study III are not as strong as they may have been, had we been able to control for different factors associated with the acquisition of the mammogram (e.g.…”

Section: Confoundingmentioning

confidence: 99%

Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program

Moshina

Ursin

Román

et al. 2016

European Journal of Radiology

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“…Compression force, (newton, N) is one way to measure breast compression. Such data is easy to collect as it is visible to radiographers at the time of imaging and stored in the DICOM-header, however, there can be substantial variation in applied compression force between breast centers and between radiographers [11,12]. Compression pressure (kilopascal, kPa) at the time of imaging is currently considered a better metric related to experienced pain, than force [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Breast compression and experienced pain during mammography by use of three different compression paddles

Moshina

Sebuødegård

Evensen

et al. 2019

European Journal of Radiology

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We aimed to compare pain experienced during screening mammography, using three different compression paddles: a fixed paddle standardizing pressure (study paddle), a flexible, and a fixed paddle. Material and methods: Using a numeric rating scale (NRS), ranged 0-10, we collected information on pain experienced during mammography from a questionnaire completed by 4,675 women screened in Stavanger, May-November 2017, as a part of BreastScreen Norway. The questionnaire also provided information on factors possibly associated with pain. Data on compression force, pressure and breast characteristics were extracted from the DICOM-header, and a breast density software. T-tests were used to compare mean values of the parameters between the types of compression paddles. Linear regression was used to determine the association of a score of ≥7 versus < 7 on NRS for experienced pain by compression paddle, adjusting for pressure, breast characteristics and associated factors. Results: The mean of experienced pain did not differ for the study and flexible paddle (2.5 on NRS), and was lower for the study paddle compared to the fixed paddle (2.4 versus 2.6 on NRS, p < 0.05). Pain in shoulder(s) and/or neck prior to mammography was associated with 33% (RR 1.33, 95%CI 1.07-1.65) higher risk of a score of ≥7 versus < 7 for experienced pain. Conclusion:The majority of women reported low scores of experienced pain during mammography, independent of compression paddle used. Further research on image quality is needed to fully understand which paddles should be preferred in a screening setting.

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Compression forces used in the Norwegian Breast Cancer Screening Program

Cited by 25 publications

References 25 publications

Influence of breast compression pressure on the performance of population-based mammography screening

Influence of breast compression pressure on the performance of population-based mammography screening

Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program

Breast compression and experienced pain during mammography by use of three different compression paddles

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