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. A Gaussian-decayed bias is applied to emphasize local column-wise correlations while suppressing distant mismatches. 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. The reconstructed 3D structure is refined and injected into the denoising UNet to guide cross-view generation with enhanced anatomical awareness. 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 real-world diagnostics.