title: Improved visualization of breast cancer features in multifocal carcinoma using phase-contrast and dark-field mammography: an ex vivo study.
abstract: OBJECTIVE
  Conventional X-ray attenuation-based contrast is inherently low for the soft-tissue components of the female breast. To overcome this limitation, we investigate the diagnostic merits arising from dark-field mammography by means of certain tumour structures enclosed within freshly dissected mastectomy samples.
  
  
  METHODS
  We performed grating-based absorption, absolute phase and dark-field mammography of three freshly dissected mastectomy samples containing bi- and multifocal carcinoma using a compact, laboratory Talbot-Lau interferometer. Preoperative in vivo imaging (digital mammography, ultrasound, MRI), postoperative histopathological analysis and ex vivo digital mammograms of all samples were acquired for the diagnostic verification of our results.
  
  
  RESULTS
  In the diagnosis of multifocal tumour growth, dark-field mammography seems superior to standard breast imaging modalities, providing a better resolution of small, calcified tumour nodules, demarcation of tumour boundaries with desmoplastic stromal response and spiculated soft-tissue strands extending from an invasive ductal breast cancer.
  
  
  CONCLUSIONS
  On the basis of selected cases, we demonstrate that dark-field mammography is capable of outperforming conventional mammographic imaging of tumour features in both calcified and non-calcified tumours. Presuming dose optimization, our results encourage further studies on larger patient cohorts to identify those patients that will benefit the most from this promising additional imaging modality.
  
  
  CONCLUSIONS
  • X-ray dark-field mammography provides significantly improved visualization of tumour features • X-ray dark-field mammography is capable of outperforming conventional mammographic imaging • X-ray dark-field mammography provides imaging sensitivity towards highly dispersed calcium grains.
authors.affiliation: Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Grandl
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748, Garching, Germany. kai.scherer@tum.de.
authors.forename: Kai
authors.initials: K
authors.lastname: Scherer
authors.affiliation: Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Anikó
authors.initials: A
authors.lastname: Sztrókay-Gaul
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748, Garching, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Birnbacher
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748, Garching, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Willer
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748, Garching, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Chabior
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748, Garching, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Herzen
authors.affiliation: Institute of Pathology, Ludwig-Maximilians-Universität München, Marchioninistr. 27, 81377, Munich, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Mayr
authors.affiliation: Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Sigrid D
authors.initials: SD
authors.lastname: Auweter
authors.affiliation: Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Franck-Strasse 1, 85748, Garching, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Pfeiffer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.affiliation: Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Hellerhoff
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008327:Mammography / Q000379:methods*; D008408:Mastectomy
keywords: Breast cancer; Grating interferometry; Mammography; X-ray dark-field imaging; X-ray phase-contrast imaging