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Abstract SUMMARY Breast cancer is the most commonly diagnosed cancer among women world wide., the most important risk factors of breast cancer are genetic predisposition, low parity, exposure to estrogens whether endogenous or exogenous, ionizing radiation, and increased breast density. Also the unhealthy diets , obesity all contribute to the rising incidence of breast cancer. Currently there is a global tendency to breast conservative surgery in the newly diagnosed cancers. However, in some patients, mastectomy is still performed. The treatment choice depends on many factors including tumor size relative to breast size, tumor multicentricity/ multifocality, inability to achieve negative surgical margins after multiple resections, or patient choice. Up to date breast cancer screening and primary diagnosis is done using digital mammography (DM). However, DM can miss up to 15-30% of all cancers,. In DM the normal breast tissue overlap can obscure cancer or create a false negative impression of cancer. This applies especially to dense breasts in child bearing period . Recently several advances in breast imaging have emerged, including contrast enhanced digital mammography (CEDM), and three dimensional ultrasound (3D US). Although not widely implemented as DM and hand held 2D US (HHUS), these advances show promising results that warrant extensive research. This study was designed to compare the role of contrast enhanced spectral mammography (CESM ) and 3D US in the differentiation of breast lesions ,excluding presence of malignant tumors and detection of |