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BREAST IMAGING CORRELATION PRACTICES AND TECHNIQUES

ANNINA N WILKES MD

THOMAS JEFFERSON UNIVERSITY HOSPITAL

MAY 2021

US/DIGITAL BREAST TOMOSYNTHESIS

Characterization of breast lesions: comparison of digital breast tomosynthesis and ultrasonography

SA Kim, JM Chang, N Cho, A Yi- Korean journal of Radiology 2015

Advances in Digital Breast Tomosynthesis

Regina J. Hooley1, Melissa A. Durand1 and Liane E. Philpotts1 -American Journal of Roentgenology. 2017;208: 256-266. 10.2214/AJR.16.17127

US/MRI CORRELATION MRI DIRECTED US( SECOND LOOK)

MR-Directed (“Second-Look”) Ultrasound Examination for Breast Lesions Detected Initially on MRI: MR and Sonographic Findings

Hiroyuki Abe1, Robert A. Schmidt, Rajshri N. Shah, Akiko ShimauchiAmerican Journal of Roentgenology. 2010;194: 370-377. 10.2214

Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis

C Spick, PBatzer - Radiology, 2014

Accuracy of ultrasonography and mammography in predicting pathologic response after neoadjuvant chemotherapy for breast cancer

Jkeune, Djeffe, M Schootman- The American Journal of Surgery 2010

US/MRI CORRELATION TUMOR SIZE

Estimation of tumor size in breast cancer comparing clinical examination, mammography, ultrasound and MRI—correlation with the pathological analysis of the surgical specimen

T Cortadellas, P Argacha, J Acosta, et al- Gland Surgery, 2017

Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests: individual patient data meta-analysis

ML Marinovich, P Macaskill, L Irwig et al- BMC cancer, 2015

Comparative accuracy of preoperative tumor size assessment on mammography, sonography, and MRI: Is the accuracy affected by breast density or cancer subtype?

R Leddy, A Irshad, A Metcalfe- Journal of Clinical Ultrasound, 2016

The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography-a retrospective multicenter cohort study of 6543 primary breast cancer patients

RG Stein, D Wollschläger, R Kreienberg- BMC cancer, 2016

Neoadjuvant chemotherapy for breast cancer: functional tumor volume by MR imaging predicts recurrence-free survival—results from the ACRIN 6657/CALGB 150007 I-SPY I Trial

NM Hylton, CA Gatsonis, MA Rosen, CD Lehmam - Radiology, 2015

DM/DBT/US/MRI

• DBT superior to DM for evaluation of mass size

• DBT and US both superior to DM for evaluation of mass size

• US at least equal or superior to MRI in predicting tumor size, MRI overestimating and limited by background enhancement

Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis C Spick, PBatzer - Radiology, 2014

MAMMOGRAM-GOLD STANDARDSCREENING/DIAGNOSTIC

• Mass

• Asymmetry

• Focal Asymmetry

• Architectural Distortion

• Calcifications

• Axillary Adenopathy

• Skin thickening/Overall increased density

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ADDITIONAL MAMMOGRAPHIC VIEWS

• Spot compression- questioned mass, asymmetry or distortion

• Spot magnification – calcifications

• Exaggerated CC views – to see more lateral posterior or medial breast

• Rolled views – to better estimate position of finding in the breast if only seen on CC view

• 90 Lateral view – for accurate localization to use with CC view to guide targeted ultrasound exam

MAM/US CORRELATION

Estimate

• position of finding on the mammogram

• quadrant (UOQ, UIQ, LOQ, LIQ)

• mammographic clock position

• distance from the nipple

• size, shape, margins

CC MLO (45) ML( 90)

POSITION“LATERAL LIES DOWN”

CC MLO (45) ML(90)

MEDIAL MOVES UP

SONOGRAPHIC POSITION

• quadrant• o’clock position• distance from the nipple• depth• size, shape margins• surrounding tissue

Position on the mammogram

Mass at posterior glandular – fat interface

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mass at anterior fat- glandular interface

28 yo woman, palpable mass oil cyst

Incidental mass

fibroadenolipoma/hamartoma

Scar

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US correlate normal breast tissue

CEM

CT-sono correlation

MRI-Sonography Correlation

R L

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MRI- sono correlation

Staging MRI

pre – neoadjuvant chemo post – neoadjuvant chemo

neoadjuvant chemotherapy response mammo – ultrasound correlation

metastatic IDC

MRI second look ultrasound

IDC

BIRADS 4B- Moderate Suspicion for malignancy

Ultrasound-Ultrasound Correlation/Biopsy Results

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Day of Imaging Day of biopsy

Stromal Fibrosis – Clip in the mass?

Post Biopsy Clip

Correlation with biopsy results

BIRADS 5- Highly Suggestive of Malignancy

PATH Granular Cell Tumor Benign Lymph Node

DISCORDANT WITH BIRADS 5 MASS

GRANULAR CELL TUMOR

• rare( 1 in 1000 in breast)

• <1% malignant

• tumor originating from Schwann cells of peripheral nerves

• painless round mass, can look like Ca on mammogram

Granular cell tumor in breast: a case report

Maria Castillo Lara, Antonia Martínez Herrera, Rafael Torrejón Cardoso, andDaniel Maria Lubián López