breast imaging -...
TRANSCRIPT
![Page 1: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/1.jpg)
SEMMELWEIS UNIVERSITY
BREAST IMAGING
![Page 2: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/2.jpg)
ANATOMY OF THE HUMAN BREAST
Normal variations: : prepubertal, pubertal, premenstrual, gestational, during lactation,
menopausal
Male breast
![Page 3: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/3.jpg)
EXAMINING TECHNIQUES
1. Medical history
Family: Breast, gynecological, prostate, colon cancer
Hormonal treatment: Postmenopausal hormon supplement, test-tube baby program
2. Physical examination - Teaching how to performa a breast self-exam
3. Mammography
2 basic views from both breast, CC, MLO
+ additional views: spot, magnification, lat-lat, etc.
CAD: computer aided diagnosis
![Page 4: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/4.jpg)
![Page 5: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/5.jpg)
MAMMOGRAPHY
Standard MLO és CC settings
![Page 6: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/6.jpg)
IMAGING MODALITIES
Tomosynthesis
![Page 7: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/7.jpg)
IMAGING MODALITIES
Mammography and tomosynthesis can be done with administration of
contrast material – better evaluation of dens breasts, extensions of tumors.
![Page 8: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/8.jpg)
IMAGING MODALITIES
5. Ultrasound
Linear transducer probe : 7,5 – 13 MHz, elastography can be useful too
Cyst Fibroadenoma Tumor
![Page 9: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/9.jpg)
IMAGING MODALITIES
ABUS - Automated Breast Ultrasound
![Page 10: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/10.jpg)
IMAGING MODALITIES6. MR
Unenhanced – evaluation of the implant
Enhanced – Tumor – borders, multifocality, scar vs. reoccurance, therapetuic response, BRCA
positive young adult, postiton to chest wall
ítélése
Tumor Implant ruptureMinimum 1,5 T
Dedicated breast coil
![Page 11: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/11.jpg)
IMAGING MODALITIES
7. PET – CT
In breast diseases it is mostly used for staging
8. Isotope diagnostics
Sentinel lymh node marking and mapping
ROLL marking - Radio Guided Occult Laesion Localisation - peroperatív marking of non-
palpable tumors
![Page 12: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/12.jpg)
INTERVENTIONS
1. Galactography (ductography)
discharging nipple
Common causes: Hormonal, papilloma
Lack of contrast filling
![Page 13: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/13.jpg)
2. Paget disease susp.: scraping cells with a slide
3. Pneumocystography
It was used for cysts with intacystic solid component
Nowadays can be well visualised with US,
biopsy can be done as well
INTERVENTIONS
![Page 14: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/14.jpg)
4. Cysts, haematomas, seromas drainage
5. Sampling
based on the thicknes of the needle and the technik: FNAB (20-22 G), core (14-16 G),
vacuum- core (8-11G)
Guidance: what gives the best visualization (UH, sztereotaxia, MR)
! Vacuum core: in some cases can be a definitive solution instead of surgery
INTERVENTIONS
![Page 15: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/15.jpg)
FNAB
Core biopsy
Vacuum coreStereotactic
![Page 16: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/16.jpg)
6. Preoperative marking/mapping (wire localization, ROLL)
7. Marker placement for neuadjuvant treatment
INTERVENTIONS
![Page 17: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/17.jpg)
BREAST EXAMINATIONS
There are „special” kinds of mammography techniques that are advertised as painless and not using ionizig radiaton:
CT-laser mammography, Electrical impedance mammography, Termographic mammography.
According to current studies they are not suitable for screening!!!
1. Diagnostic
if symptomps are present
under 30 years: first modality: US
above 35 years : mammography (+UH)
between 30- 35 years : based on individual
needs
2. Screening
Organized or opportunistic
Oranized by ÁNTSZ – National Public
Health and Medical Officers’s Service
Hungary: between 45-65 years in every 2
years
![Page 18: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/18.jpg)
BREAST DISEASES
1. Benign conditions
Developmental anomalies
Benign tumors: fibroadenoma, lipoma, hamartoma, phylloid,
Papilloma
2. Pseudotumors – dystrophies
3. Mastopathies
4. Other conditions
galactocele, retroareolar cysts, epidermoid cysts, Mondor-disease
(superficial thromophlebitis), etc.
![Page 19: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/19.jpg)
BREAST DISEASES
5. Inflammation
acute – infection, postpartum, lymphangitis, abscess
chronic – tbc, syphilis, sarcoidosis
traumatic
plasma cell mastitis (secreting ductectasia)
granulomatosus mastitis – autoimmun causes
![Page 20: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/20.jpg)
BREAST DISEASES
6. malignant tumors
carcinomas:
lobular in situ: 1 %
lobular infiltrative: 5 %
ductal in situ: 2 %
ductal invasive: 75 %
sarcomas: phylloid tumor, fibrosarcoma, liposarcoma, great cell, leiomyosarcoma
metastases: melanoma, lymphoma, genital cc, lung, GI cancers,
![Page 21: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/21.jpg)
INTERPRETATION OF MAMMOGRAPHY
Asymmetric density:
round or oval laesion
star shaped laesion
not specific asymmetric density
Microcalcification with tumor shadow
Microcalcification without tumor shadow
Retromamillar variances
![Page 22: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/22.jpg)
FEATURES OF BENIGN CONDITIONS
SHAPE: Round or rounded, oval
MARGIN: Smooth, macrolobulated
BORDERS: Sharp
Capsule
Halo sign
Partially or totally ill-defined
DENSITY: Radiolucent
Mixed
Low
Dens
CALCIFICATIONS: Common, mostly benign-like
![Page 23: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/23.jpg)
BENIGN CONDITIONS
Fibroadenoma Cyst Fat necrosis
![Page 24: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/24.jpg)
FEATURES OF MALIGNANT CONDITIONS
SHAPE: Irregular, Star-shaped, rarely round
MARGINS: Irregular, spiculated, microlobulated
BORDERS: Partially or fully ill-defined
DENSITY: Usually high
CALCIFICATAIONS: Malignant-like
![Page 25: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/25.jpg)
CALCIFICATIONS
OCCURANCE:
intraductal
intralobular
extraglandular
SIZE:
micro and macrocalcifications
DISTRIBUTION: grouped (soliter, multiplex), diffuse
TYPES: benign malignant
FEATURES: monomorf or polymorf
Calcifications can not be evaluated well with other modalities
![Page 26: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/26.jpg)
Cluster Branching Powder-like
CALCIFICATIONS
![Page 27: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/27.jpg)
TREATING BREAST CANCER
ONCOLOGICAL TEAM:
oncologist
surgeron – with oncoplastic fellowship!!!
pathologist
radiation oncologist
radiologist
INTERDISCIPLINARY WORK IS CRUCIAL!
![Page 28: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/28.jpg)
TYPES OF BREAST SURGERIES
breast cosmetic surgery (reduction, mastopexia, breast augmentation with implants)
tumor
lumpectomy
sector resection
quadrantectomy
mastectomy
+ SNB = sentinel lymph node biopsy
if necessary ABD : axillary block dissection
reconstructive – primer or elective
with implant or with own flap (TRAM, LD)
![Page 29: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/29.jpg)
Reconstructive surgey with TRAM flap
Tatto after mestectomy
POSTOPERATIVE OPTIONS
![Page 30: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/30.jpg)
POSTOPERATIVE OPTIONS
Reconstruction with silicon implant
![Page 31: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/31.jpg)
MALE BREAST
Breast cancer - examination, treatment, just as in case of the female breast
Gynecomasty
Most common age: Teenagers and middle aged men
Background: Mostly hormonal
Urological conditions: Testis, prostate
Internal medicine: endocrine és hepatic diseases
Drugs: digitalis, anabolic drugs
Tumors: Testis and lung
Mammography and US: retromamillar gland tissue is visible
![Page 32: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/32.jpg)
CLINICAL CASES
![Page 33: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/33.jpg)
EXTRACAPSULAR RUPTURE
Free silicon, silicon in the lymph nodes as well, US is
sufficient
![Page 34: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/34.jpg)
INTRACAPSULAR RUPTURE
linguini sign , keyhole sign, salad-oil sign
![Page 35: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/35.jpg)
TUMOR
LEFT CC LEFT MLO US
![Page 36: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/36.jpg)
CYST
Right CC Right MLO US
![Page 37: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/37.jpg)
FIBROADENOMA
Left CC Left MLO US
![Page 38: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/38.jpg)
PRACTICE
Inspecting the mammography machine, setting the
correct image postitons
Inspecting the tomosynthesis (DBT) on a phantom
Intervencional tools (Cameco, core biopsy pistol,
localisation wire, tumor marker)
![Page 39: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/39.jpg)
SUMMARY
Importance of breast self-exam!
Not every lump is a tumor!
Look for calcifications!
Males have breasts too!
![Page 40: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/40.jpg)
EXAM PICTURES
SELECTED PICTURES FROM THE WEBSITE:
Number: 49, 50, 51
![Page 41: BREAST IMAGING - semmelweis.husemmelweis.hu/kepalkotas/files/2019/10/EN-Breast-imaging-lecture.pdfEXAMINING TECHNIQUES 1. Medical history Family: Breast, gynecological, prostate, colon](https://reader033.vdocument.in/reader033/viewer/2022041915/5e693f7be432f052f7740edf/html5/thumbnails/41.jpg)
Thank you for your attention!