Jerry E. De Groot MS, Presenter: Nothing to Disclose

Gerard J. Den Heeten MD, PhD, Abstract Co-Author: Research Consultant, Koninklijke Philips Electronics NV, Eindhoven, Netherlands

Cornelis A. Grimbergen PhD, Abstract Co-Author: Nothing to Disclose

To investigate the consequences of breast conservative therapy (BCT) on the elastic properties of breast tissue and the consequences for the compression strategy and concomitant discomfort during mammography.

A clinical trial investigating the mechanical aspects of compression during mammography is carried out involving up to 500 patients. All women undergoing mammography performed in our hospital, are asked to participate. During the compression cycle additional measurements of contact area enabling estimation of mean pressure and of pain experienced during digital mammography producing a craniocaudal (CC) and a mediolateral oblique (MLO) view. The pain is assessed with a dynamic pain measurement using a turning knob with an audible tone controled by the patient; afterwards, a visual analogue scale (VAS) evaluation is recorded in a questionnaire. In this particular part of the study, we focused on patients with BCT (including postoperative radiotherapy) in one breast (30% of the patients). We were able to analyze the mechanical properties of the treated and untreated breast during compression and the accompanying symptoms.

The outcomes of our study show that the stiffness of the breasts having received BCT is significantly higher (2.44 +/- 1.3) than that of the untreated breast. This leads to a significantly smaller contact area (70 +/- 20%) and consequently to a larger tissue pressure at a certain compression force for the treated breast. In addition, it can be shown that the reduction in tissue thickness is very limited with a large increase in pain experience; for instance halving the applied force results in an increased thickness of only a few millimeters (3.8 +/- 2%) vs (5.6 +/- 3%) for the untreated breast.

The breast conservative therapy leads to significantly reduced tissue elasticity relative to the untreated breast. In our view, the compression strategy should be adapted to limit the additional tissue pressure causing excessive discomfort and very limited reduction of tissue thickness. The applied compression force should be reduced in proportion to the reduced tissue elasticity.

Taking the elastic properties of breast tissue into account in BCT, will limit the extent of discomfort and standardize tissue compression.

De Groot, J, Den Heeten, G, Grimbergen, C, The Influence of Breast Conservative Therapy on Discomfort and Pain Experience during and after Mammographic Compression.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9004741.html