الفهرس 
Anatomy of the BreastOnly 14 pages are availabe for public view
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Abstract
Breast lesions are a wide spectrum of heterogonous diseases, although benign lesions are the vast majority yet malignant lesions are of the most concern, in Egypt, breast cancer is the most common cancer among women, representing 37 % of all female cases.
We compared in our study between digital mammography and Tomosynthesis in the detection of breast lesions, which is very challenging especially in those females with dense breasts, and still the most challenging is detection of breast cancer as early as possible.
Digital mammography is a two-dimensional imaging modality and currently the golden role in detecting breast lesions, especially cancers at an early stage and is the only screening modality proved to reduce mortality and morbidity. However, it has several weakness and draw backs which affect this role such as tissue overlapping and unclear lesion margins, attributed to the clutter of signals from tissues above and below the lesions and because the signal detected is dependent upon the total attenuation of all the tissues above the location.
On the other hand, Tomosynthesis is a three-dimensional imaging that reduces tissue overlap, its technology depends on acquisition of multiple projection exposures by digital detector from X-Ray tube which moves over a limited arc angle, these projection images are reconstructed using specific algorithms and presented as a series of images for the entire breast which are read at workstation. Image accusation of both modalities is the same; two views are acquired CC and MLO, yet in DM tube is fixed and in Tomo tube moves over an angle.
The present study confirms: the potential role for Tomo in improving the detection, characterization and accuracy of breast lesions. We reported more masses detection whether malignant or benign regardless of breast composition or age by Tomo comparing to DM; malignant lesions detection was 38.5% by Tomo and 20% by DM with 18.5 % difference in favor of Tomo, benign lesions detection was 40% by Tomo and 26.25% by DM with difference 13.75% in favor of Tomo, and total lesions detection was 77.50% by Tomo and 41.25% by DM with 36.25% difference in favor of Tomo.
Tomo showed higher sensitivity than DM; it measured 95.31 % and 51.56 respectively, also higher specificity which was 100 % and 93.75 respectively.
Tomo also recorded higher positive predictive value comparing to DM; it was 100 % and 97.06 % respectively, higher negative predictive value measured 84.21 % and 32.61% respectively and higher accuracy measured 96.25 % and 60 % respectively.
Regarding lesion characterization and tumor margin, Tomo was superior comparing to DM; it changed diagnosis and management, increased true lesions and reduced false lesions, as after applying Tomo, it upgraded 25% of all patients to BIRADS 4c and 5, downgraded 53.75 % of all patients to BIRADS 2 and 3, even in the breast lesions which showed the same BIRADS results as DM (21.25 % of all patients), Tomo was superior in detecting more details than DM in tumor margin, extension, stromal invasion, multi-centricity, and multifocality.
The potential clinical applications of Tomo are; clarification of equivocal lesions, determination of the exact extent of disease, delineating tumor margins, lesion characterization and detection of occult lesions in DM, particularly in dense breast. Tomo proved itself in screening and diagnostic clinical practice and we believe that it is a strong adjunct to other tools in these two fields and highly comparable to CEDM (contrast enhanced DM) and Dynamic MR-mammography in detection of missed lesions, yet without using contrast dye and less time-consuming, but still Tomo needs further improvements in micro-calcifications detection, we believe with fast improvements and new technology every day, Tomo will overcome this problem.