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Is Individualizing Breast Compression during Mammography useful? – Investigations of pain indications during mammography relating to compression force and surface area of the compressed breastArticle in several languages: English | deutsch
15 January 2016
02 October 2016
21 December 2016 (online)
Purpose The aim of this paper is to determine how the presence of pain during mammographic compression could be reduced. To this end, we examine its relationship with compression force, surface-area of the compressed breast, breast density (ACR) and former operations.
Materials and Methods In 199 women 765 mammograms were performed. Women were asked to rate the level of pain on a scale of 0 – 10 (0: no, 10: highest pain). The surface-area of the breast under compression captured by the mammograms was measured using planimetry. 52 of the 199 women were asked to identify the area of the upper body with the highest level of pain.
Results The thickness of the compressed breast was 65.2 % of the uncompressed breast at a force of 10 daN (57.8 % at 15 daN). When the force was increased from 10 daN to 15 daN, the average glandular dose (AGD) declined by 17 %. Tolerance of compression was associated with the size of the breast. More than 50 % of the mammograms with a small compression less than 9 daN were associated with higher level of pain. In the oblique projection, 60 % of the women specified the axilla as the area of maximum pain.
Conclusion Women with larger breasts tolerated a greater force of compression. This implies a need for individualised examination depending on the size of the breast. Women with increased pain susceptibility terminated the compression early regardless of a small compression less than 9 daN. More than 50 % of the women identified areas outside breast as especially painful. Therefore, during examination, the areas around the breast should also be taken into consideration in order to minimize unnecessary discomfort.
With increased mammographic compression force, the effectiveness of breast thickness reduction declined.
A compression force of 15 daN enabled an additional reduction by 17 % in average glandular dose (AGD) compared to 10 daN.
Tolerance of increased compression force was related to breast surface area.
Women with increased susceptibility of pain terminated the compression at a low force of less than 9 daN
Pain relating to the mammographic procedure was identified outside the breast by more than 50 % of the women.
Feder K, Grunert JH. Is Individualizing Breast Compression during Mammography useful? – Investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Fortschr Röntgenstr 2017; 189: 39 – 48
- 1 Perry N. Broeders MJ. de Wolf C. et al. (eds) European guidelines for quality assurance in breast cancer screening and diagnosis (fourth edition). Nijmegen: The European Commission, in cooperation with EUREF, EBCN and EUSOMA; 2006 erreichbar unter: http://www.euref.org/european-guidelines/4th-edition
- 2 Bundesärztekammer. Leitlinie zur Qualitätssicherung in der Röntgendiagnostik. B Katalog spezifischer ärztlicher und aufnahmetechnischer Qualitätsanforderungen bei Röntgenuntersuchungen. Berlin: 2007 erreichbar unter: http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/LeitRoentgen2008Korr2.pdf
- 3 Sommer A. Schopphoven S. Land I. et al. Prüfanleitung für die Bestimmung der mittleren Parenchymdosis nach DIN 6868-162 und des Kontrastauflösungsvermögens nach Qualitätssicherungs-Richtlinie für digitale Mammografieeinrichtungen-Leitfaden der deutschen Referenzzentren für Mammografie Version 2.0. Fortschr Röntgenstr 2014; 186: 474-481
- 4 Helvie MA. Chan HP. Adler DD. et al. Breast thickness in routine mammograms: effect on image quality and radiation dose. American journal of roentgenology 1994; 163: 1371-1374
- 5 Keemers-Gels ME. Groenendijk RP. van den Heuvel JH. et al. Pain experienced by women attending breast cancer screening. Breast cancer research and treatment 2000; 60: 235-240
- 6 Whelehan P. Evans A. Wells M. et al. The effect of mammography pain on repeat participation in breast cancer screening: a systematic review. Breast (Edinburgh, Scotland) 2013; 22: 389-394
- 7 de Groot JE. Broeders MJ. Branderhorst W. et al. Mammographic compression after breast conserving therapy: controlling pressure instead of force. Medical physics 2014; 41: 023501
- 8 Kornguth PJ. Keefe FJ. Wright KR. et al. Mammography pain in women treated conservatively for breast cancer. The journal of pain: official journal of the American Pain Society 2000; 1: 268-274
- 9 Cockburn J. Cawson J. Hill D. et al. An analysis of reported discomfort caused by mammographic X-ray amongst attenders at an Australian pilot breast screening program. Australasian radiology 1992; 36: 115-119
- 10 Keemers-Gels ME. Groenendijk RP. van den Heuvel JH. et al. Pain experienced by women attending breast cancer screening. Breast cancer research and treatment 2000; 60: 235-240
- 11 Göktan C. Taskin O. Mammography-related pain and anxiety. Diagnostic and interventional radiology (Ankara, Turkey) 2005; 11: 175
- 12 Van Goethem M. Mortelmans D. Bruyninckx E. et al. Influence of the radiographer on the pain felt during mammography. European radiology 2003; 13: 2384-2389
- 13 Wiratkapun C. Lertsithichai P. Wibulpolprasert B. et al. Breast pain and service satisfaction during digital mammography. Journal of the Medical Association of Thailand 2006; 89: 1864-1873
- 14 Gupta R. Nayak M. Khoursheed M. et al. Pain during mammography: impact of breast pathologies and demographic factors. Medical principles and practice: international journal of the Kuwait University 2003; 12: 180-183
- 15 Dullum JR. Lewis EC. Mayer JA. Rates and correlates of discomfort associated with mammography. Radiology 2000; 214: 547-552
- 16 Kornguth PJ. Rimer BK. Conaway MR. et al. Impact of patient-controlled compression on the mammography experience. Radiology 1993; 186: 99-102
- 17 Bruyninckx E. Mortelmans D. Van Goethem M. et al. Risk factors of pain in mammographic screening. Social science & medicine 1999; 49: 933-941
- 18 Miller D. Livingstone V. Herbison P. Interventions for relieving the pain and discomfort of screening mammography. The Cochrane database of systematic reviews 2008; 2942
- 19 Miller D. Martin I. Herbison P. Interventions for relieving the pain and discomfort of screening mammography. The Cochrane database of systematic reviews 2002; 2942
- 20 de Groot JE. Branderhorst W. Grimbergen CA. et al. Towards personalized compression in mammography: a comparison study between pressure- and force-standardization. European journal of radiology 2015; 84: 384-391
- 21 de Groot JE. Broeders MJ. Branderhorst W. et al. A novel approach to mammographic breast compression: Improved standardization and reduced discomfort by controlling pressure instead of force. Medical physics 2013; 40: 81901
- 22 Branderhorst W. de Groot JE. Highnam R. et al. Mammographic compression--a need for mechanical standardization. European journal of radiology 2015; 84: 596-602
- 23 Fischer U. (ed) ACR BI-RADS: illustrierte Anleitung zur einheitlichen Befunderstellung von Mammografie, Mammasonografie, MR-Mammografie. Ausgabe 2 Stuttgart: Thieme; 2006: 174
- 24 Siemens. Mammography Applications for Mammomat 1000/3000 Nova. Erlangen: Siemens AG; 2004 erreichbar unter: http://www.healthcare.siemens.com/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/groups/public/@global/@imaging/@mammo/documents/download/mdaw/mtux/~edisp/mammomat-1000-mammography-applications-00009977.pdf
- 25 Harrington S. Gilchrist L. Sander A. Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Pain. Rehabil Oncol 2014; 32: 13-21
- 26 de Groot JE. Broeders MJ. Grimbergen CA. et al. Pain-preventing strategies in mammography: an observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle. BMC women's health 2015; 15: 185
- 27 Markle L. Roux S. Sayre JW. Reduction of discomfort during mammography utilizing a radiolucent cushioning pad. The breast journal 2004; 10: 345-349
- 28 Kornguth PJ. Keefe FJ. Conaway MR. Pain during mammography: characteristics and relationship to demographic and medical variables. Pain 1996; 66: 187-194
- 29 Tabar L. Lebovic GS. Hermann GD. et al. Clinical assessment of a radiolucent cushion for mammography. Acta radiologica 2004; 45: 154-158
- 30 Dibble SL. Israel J. Nussey B. et al. Mammography with breast cushions. Women's health issues: official publication of the Jacobs Institute of Women's Health 2005; 15: 55-63
- 31 Timmers J. Voorde MT. Engen RE. et al. Mammography with and without radiolucent positioning sheets: Comparison of projected breast area, pain experience, radiation dose and technical image quality. Eur J Radiol 2015; 84: 1903-1909
- 32 Broeders MJ. Ten Voorde M. Veldkamp WJ. et al. Comparison of a flexible versus a rigid breast compression paddle: pain experience, projected breast area, radiation dose and technical image quality. Eur Radiol 2015; 25: 821-829