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Senologie - Zeitschrift für Mammadiagnostik und -therapie 2017; 14(01): 26-35
DOI: 10.1055/s-0043-102537
Wissenschaftliche Arbeit
© Georg Thieme Verlag KG Stuttgart · New York

Ist eine Individualisierung der mammografischen Brustkompression sinnvoll? – Untersuchungen zu Schmerzangaben bei der Mammografie in Bezug auf Kompressionskraft und Fläche der komprimierten Brust

Is Individualizing Breast Compression during Mammography useful? – Investigations of pain indications during mammography relating to compression force and surface area of the compressed breast
Katarzyna Feder
1   Centre for Radiology, Hannover Medical School, Hannover
,
Jens-Holger Grunert
2   Radiology Practice Georgstraße, Hannover
› Author Affiliations
Further Information

Publication History

15 January 2016

02 October 2016

Publication Date:
27 March 2017 (online)

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Zusammenfassung

Ziel Ziel der Arbeit ist es zu ermitteln, wie das Schmerzempfinden bei der mammografischen Kompression reduziert werden kann. Hierfür untersuchten wir seine Beziehung zur Kompressionskraft, Fläche der komprimierten Brust, Brustdichte (ACR) und Voroperationen.

Material und Methodik Bei 765 Mammografien von 199 Patientinnen wurden die Kompressionsschmerzen auf einer Skala von 0 – 10 bewertet (0: keine, 10: stärkste Schmerzen). Die Fläche der Brust wurde im Mammogramm planimetriert. Bei 52 der 199 Frauen wurde das Thoraxwandareal mit den größten Schmerzen abgefragt.

Ergebnisse Die Dicke der komprimierten Brust entsprach 65,2 % der Dicke der nicht komprimierten Brust bei einer Kraft von 10 daN (57,8 % bei 15 daN). Eine Erhöhung der Kraft von 10 auf 15 daN führte zu einer zusätzlichen Reduktion der Parenchymdosis (AGD) um 17 %. Die Toleranz der Kompressionskraft war von der Größe der Brust abhängig. Über 50 % der Mammografien mit einer geringen Kompression von weniger als 9 daN waren mit stärkeren Schmerzen assoziiert. Bei den Schrägprojektionen war bei 60 % der Frauen die Axilla das schmerzhafteste Areal.

Schlussfolgerung Frauen mit einer größeren Brust tolerierten eine größere Kompressionskraft. Dies legt eine Individualisierung der Untersuchung in Abhängigkeit von der Größe der Brust nahe. Frauen mit einem erhöhten Schmerzempfinden beendeten die Kompression frühzeitig trotz einer geringen Kraft von weniger als 9 daN. Mehr als 50 % der Frauen empfanden Areale außerhalb der Brust als besonders schmerzhaft. Es sollte daher während der Untersuchung darauf geachtet werden, auch Areale außerhalb der Brust zu schonen.

Abtract

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.

Schlüsselwörter

Brust - Mammografie - technische Aspekte - Röntgen der Brust

Key words

breast - mammography - technical aspects - breast radiography
 

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