Mamografías 3D, ¿son mejores que las 2D?

En los últimos años, las mujeres que se realizan mamografías tienen una decisión a tomar: 2-D o 3-D?
La mamografía, tanto 2-D como 3-D, es una técnica de diagnóstico basada en los rayos X. La diferencia entre estas es que la segunda de ellas toma fotografías desde distintos ángulos alrededor del pecho, que se combinan posteriormente para realizar una imagen de 3 dimensiones, en cambio, la mamografía estándar solo fotografía desde dos ángulos distintos, generando así una imagen plana del órgano femenino.
El uso de las mamografías 3-D se ha disparado en los últimos años pasando de ser un 12,9% de mamografías realizadas en 2015 a 43,2% a finales del 2017. Esta tecnología, conocida también como digital breast tomosynthesis (TMIST).
Algunos de los centros de diagnóstico que aplican esta nueva tecnología han denotado que la mamografía tridimensional tiene un mayor grado de sensibilidad y precisión en temas de imagen. Es por ello que se ha abierto una investigación alrededor de este tema para conseguir mejores resultados en los próximos diagnósticos.
Este plus de sensibilidad puede ayudar a diagnosticar más casos de cáncer de pecho. Un estudio en 2014 detectó que la ratio de cánceres detectados con mamografías 2-D era de 4,2‰ y con mamografía 3-D aumentaba a 5,4‰, siendo esta diferencia estadísticamente significativa.
La investigación también sugiere que las imágenes tridimensionales, al ser más sensibles, reducen la frecuencia en que un radiólogo identifica un resultado sospechoso y se le aplica un seguimiento, además de reducir el número de falsos positivos que se asocian a una mayor tasa de visita por seguimiento. La idea es que las imágenes 3-D aporten al radiólogo más información para facilitarle la distinción entre las áreas normales y las anormales generando un ahorro tanto para el Sistema Sanitario como para las mujeres en tiempo, coste y estrés.
Los primeros hallazgos a favor de la mamografía 3-D provienen de estudios observacionales o análisis posteriores a la detección del cáncer, con lo cual no hay evidencia de un mayor beneficio en mamografías anuales de control en mujeres sin un diagnóstico realizado. Es por ello que se están poniendo en marcha nuevos ensayos controlados en los que, a mujeres aleatorias, se les asigna un método al azar de detección, lo que permite a los investigadores hacer una comparación directa y aportar más claridad sobre los beneficios y los daños de la TMIST en los próximos años. Estos ensayos evaluarán si la tecnología 3D reduce el número de mujeres con diagnóstico de cáncer de mama avanzado, las que tienen más probabilidades de propagarse a otras partes del cuerpo y causar la muerte, observando así la mortalidad dentro de este tipo de cánceres.
De momento se sugiere que, pese a su mayor grado de precisión, la evidencia de que la tecnología 3D actual reduce el número de muertes por cáncer de mama sigue sin existir, pero no se pierde la esperanza de una reducción en la mortalidad en cáncer de mama gracias a esta nueva tecnología.
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