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

Abstract

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.

Mammographic compression practices of force‐ and pressure‐standardisation protocol: A scoping review

“…The retained articles consisted of a mixture of quantitative study methods. There were six prospective 8,9,14,20–22 and eleven retrospective studies, 1,6,7,10,12,13,15–17,23,24 with one case–control study 5 . Publication dates ranged from 2004 to 2019, with the last publication being a 2019 retrospective cohort study 24 .…”

“…Publication dates ranged from 2004 to 2019, with the last publication being a 2019 retrospective cohort study 24 . Eleven studies were sourced from the Netherlands, 5–8,10,12–14,20,21,23 with one remaining publication originating from Malaysia, 24 two from Norway, 1,22 three from the United Kingdom 15–17 and one from Australia 9 . Twelve studies focussed on an asymptomatic screening population; 1,6,7,9,12,14–17,20,22,23 however, three studies investigated a diagnostic/post‐intervention population; 5,8,21 and three studies considered both screening/diagnostic populations simultaneously 10,13,24 .…”

“…Eleven studies were sourced from the Netherlands, 5–8,10,12–14,20,21,23 with one remaining publication originating from Malaysia, 24 two from Norway, 1,22 three from the United Kingdom 15–17 and one from Australia 9 . Twelve studies focussed on an asymptomatic screening population; 1,6,7,9,12,14–17,20,22,23 however, three studies investigated a diagnostic/post‐intervention population; 5,8,21 and three studies considered both screening/diagnostic populations simultaneously 10,13,24 . Twelve studies 1,5,7,8,10,13–16,20,22,24 investigated both standard mammographic views (cranio‐caudal (CC) and mediolateral oblique (MLO)), two studies investigated only the MLO view, 6,12 and one study investigated only the CC view 23 .…”

“…Twelve studies focussed on an asymptomatic screening population; 1,6,7,9,12,14–17,20,22,23 however, three studies investigated a diagnostic/post‐intervention population; 5,8,21 and three studies considered both screening/diagnostic populations simultaneously 10,13,24 . Twelve studies 1,5,7,8,10,13–16,20,22,24 investigated both standard mammographic views (cranio‐caudal (CC) and mediolateral oblique (MLO)), two studies investigated only the MLO view, 6,12 and one study investigated only the CC view 23 . Two studies 22,23 were conducted from an equipment‐based perspective, focussing mainly on the compression paddle.…”

“…Furthermore, mammography is the preliminary imaging modality used in most diagnostic settings (depending on patient age); calcium deposits, most frequently benign, can be indicative of potentially cancerous pathological change, which are usually seen clearly on a mammogram 4,5 . Breast compression is necessary for any successful mammographic examination; many sources discuss the effect of a uniform breast tissue thickness on improving image contrast and quality, with an associated reduction in radiation dose, geometric/motion blurring and tissue superimposition 1,5–14 . Whilst ultimately aiding in the detection of pathology, the discomfort attributed to breast compression remains the highest reason for patient non‐compliance with screening programs and lack of diagnostic lesion visibility 9,15,16 .…”