Bidirectional Mammogram View Translation with Column-Aware and Implicit 3D Conditional Diffusion

Dual-view mammography, including craniocaudal (CC) and mediolateral oblique (MLO) projections, offers complementary anatomical views crucial for breast cancer diagnosis. However, in real-world clinical workflows, one view may be missing, corrupted, or degraded due to acquisition errors or compression artifacts, limiting the effectiveness of downstream analysis. View-to-view translation can help recover missing views and improve lesion alignment. Unlike natural images, this task in mammography is highly challenging due to large non-rigid deformations and severe tissue overlap in X-ray projections, which obscure pixel-level correspondences. In this paper, we propose Column-Aware and Implicit 3D Diffusion (CA3D-Diff), a novel bidirectional mammogram view translation framework based on conditional diffusion model. To address cross-view structural misalignment, we first design a column-aware Cross-Attention mechanism that leverages the geometric property that anatomically corresponding regions tend to lie in similar column positions across views. Furthermore, we introduce an implicit 3D structure reconstruction module that back-projects noisy 2D latents into a coarse 3D feature volume based on breast-view projection geometry. Extensive experiments demonstrate that CA3D-Diff achieves superior performance in bidirectional tasks, outperforming state-of-the-art methods in visual fidelity and structural consistency. Furthermore, the synthesized views effectively improve single-view malignancy classification in screening settings, demonstrating the practical value of our method in realworld diagnostics. Our code is available at https://github.com/lixinHUST/CA3D-Diff.