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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
