Diagnostic methods in Diagnostic methods in mamologymamology

Bendová M, Gojiš O.Bendová M, Gojiš O.

Gynekologicko-porodnická klinikaGynekologicko-porodnická klinika

3.LF UK a FN KV PRAHA 103.LF UK a FN KV PRAHA 10

History History Medical physical and self – examination Medical physical and self – examination

Diagnostic methodsDiagnostic methods

A.Salomon 1913 A.Salomon 1913 X-ray detection of the calcifikation X-ray detection of the calcifikation

Kleinschmidt 1927 – 1st MG Kleinschmidt 1927 – 1st MG

R.Bláha 1937 – X-ray difirentiation of the R.Bláha 1937 – X-ray difirentiation of the benign and ca lesions of the breast benign and ca lesions of the breast

70´ 70´

Techniques improvementsTechniques improvements (Siemens, Philips, GE)(Siemens, Philips, GE) New MGNew MG– xeromamografie – xeromamografie

1965 Ruzicka, Wolfe 19721965 Ruzicka, Wolfe 1972 UltrasoundUltrasound

B-mode 197l, real-time pictureB-mode 197l, real-time picture

1980-90´1980-90´ Stereotaxis,Stereotaxis, digital displaydigital display

Screening MGScreening MG - -Improvement of the screening Improvement of the screening

programme- early stage of the diseaseprogramme- early stage of the disease

Genetic ex.Genetic ex.–BRCA1,2–BRCA1,2

Karcinomy prsuKarcinomy prsu

Non-genetic caNon-genetic ca- 90 %- 90 % HereditaryHereditary– 10 %– 10 %

- onkogenesonkogenes- supresors genessupresors genes- DNA repair genes DNA repair genes

BRCA 1 and BRCA 2 BRCA 1 and BRCA 2

BRCA 1 52 % (families)BRCA 1 52 % (families) BRCA 2 32 % (families)BRCA 2 32 % (families) Other genes 16% (families)Other genes 16% (families)Risk of Ca mammae 85 %, Risk of Ca mammae 85 %,

Compare to normal population 10%.Compare to normal population 10%.

Ca ovarii 60% (BRCA 1), resp. 20%Ca ovarii 60% (BRCA 1), resp. 20%

Compare to normal population 2%Compare to normal population 2%

BRCA 1 a 2BRCA 1 a 2

BRCA 1BRCA 1

-breast ca 85 %-breast ca 85 %

-meta deposits 60 %-meta deposits 60 %

-ovarian ca 60 %-ovarian ca 60 %

-colorectal ca 4%-colorectal ca 4%

-prostate ca 3%-prostate ca 3%

BRCA 2BRCA 2- breast ca 85 %- breast ca 85 %- meta deposits 60 %- meta deposits 60 %- ovarian ca 20 %- ovarian ca 20 %-gall blader ca RR 5-gall blader ca RR 5-Ca pankreas RR 3,5-Ca pankreas RR 3,5-Ca gastric RR 2,5-Ca gastric RR 2,5-Ca prostate RR 4,5-Ca prostate RR 4,5-MM RR 2,5-MM RR 2,5-colorectal Ca RR 4-colorectal Ca RR 4-male breast ca 6 %-male breast ca 6 %

Jiné syndromy s rizikem C 50Jiné syndromy s rizikem C 50

Li-Fraumeni syLi-Fraumeni sy (+sarkoms, hematol.malignancies, renal ca, tumory CNS)(+sarkoms, hematol.malignancies, renal ca, tumory CNS)

Ataxia telangiectaticaAtaxia telangiectatica (+ hematol.malignancies, Ca gastric, Ca endometrial, CNS, (+ hematol.malignancies, Ca gastric, Ca endometrial, CNS,

skin)skin)

Peutz-Jeghers syPeutz-Jeghers sy (+Ca cerv.uteri, colorectal Ca, Ca pankreas, Ca gastric)(+Ca cerv.uteri, colorectal Ca, Ca pankreas, Ca gastric)

Cowden syCowden sy (+ Ca gl. thyoidei– ne medular, hamartoms of the skin)(+ Ca gl. thyoidei– ne medular, hamartoms of the skin)

Lynch syLynch sy (+ colorectal Ca, endometrial ca, Ca hepatobiliar and (+ colorectal Ca, endometrial ca, Ca hepatobiliar and

urinary tract ca, CNS, skin)urinary tract ca, CNS, skin)

Dg of the BRCA 1, 2 positive patients Dg of the BRCA 1, 2 positive patients

FemaleFemaleSelf examinationSelf examinationClinical examination Clinical examination UltrasoundUltrasoundMGMGMRIMRIAbd. USAbd. USTumor markery Tumor markery

(CA 125, CEA, CA 15-3)(CA 125, CEA, CA 15-3)Blood ex. Blood ex. colonoscopycolonoscopySkin examinationSkin examinationProfylaktic ME a AE bilat.Profylaktic ME a AE bilat.

Male Male Self examinationSelf examinationBlood ex Blood ex Tu markery Tu markery

(CEA, CA 19-9, PSA)(CEA, CA 19-9, PSA)colonoskopycolonoskopyProstate ex. Prostate ex. (per rec. a UZ)(per rec. a UZ)Abd USAbd USSkin ex. Skin ex.

Invasive methods Invasive methods Fine-needleFine-needle cytology cytology Core cut biopsieCore cut biopsie Vakuum biopsyVakuum biopsy

Peroperative Xray control,Peroperative Xray control, Peroperative biopsyPeroperative biopsy

SNB – frozen section SNB – frozen section

Diagnostic methods Diagnostic methods MGMG

USUS

BIOPSY - FNB, core – cut biopsyBIOPSY - FNB, core – cut biopsy

DUKTOGRAFYDUKTOGRAFY

MRI MRI

CT, PET - CT CT, PET - CT

SCREENING MG - SMGSCREENING MG - SMG SMGSMG for asymptomatic women 45-75 years for asymptomatic women 45-75 years - every 24 months - every 24 months

- event. + US - event. + US

- In Czech rep only 50 % regulary scannedIn Czech rep only 50 % regulary scanned

- Target: is to get the preinvasive forms of the tumor Target: is to get the preinvasive forms of the tumor within the 1st stage of the disease within the 1st stage of the disease

Dg methods Dg methods

VACUUM MAMOTOMY VACUUM MAMOTOMY

PET - CT, CTPET - CT, CT TERMOGRAFYTERMOGRAFY RADIOMETRIE RADIOMETRIE IMPEDANT TOMOGRAFYIMPEDANT TOMOGRAFY

CTLMCTLM -- COMPUTED TOMOGRAPHY LASER COMPUTED TOMOGRAPHY LASER MAMOGRAPHYMAMOGRAPHY not any more…..not any more…..