SYB 1 Erin Gundersen MS IV

Breast Cancer Breast Cancer

Main Types  In Situ- tumor cells confined to ducts and lobules with no invasion Ductal Ductal CalcificationsCalcifications Palpable massPalpable mass Lobular Lobular Not palpable, no mammographic appearanceNot palpable, no mammographic appearance Incidental findingIncidental finding Increase risk of invasive cancerIncrease risk of invasive cancer

Main Types  Invasive Carcinoma- invade breast stroma, can spread or metastasize Infiltrating ductal — 76 percent Infiltrating ductal — 76 percent Invasive lobular — 8 percent Invasive lobular — 8 percent Ductal/lobular — 7 percent Ductal/lobular — 7 percent Mucinous (colloid) — 2.4 percent Mucinous (colloid) — 2.4 percent Tubular — 1.5 percent Tubular — 1.5 percent Medullary — 1.2 percent Medullary — 1.2 percent Papillary — 1 percent Papillary — 1 percent

Mammography  Spiculated soft tissue mass Most specific- 90% are invasive CA Most specific- 90% are invasive CA  Clustered microcalcifications- 0.1 to 1 mm in diameter, and numbering more than 4 to 5 per cubic centimeter Intraductal necrotic tumor Intraductal necrotic tumor DCIS DCIS Mucin-secreting tumors Mucin-secreting tumors Benign- vascular, skin, rim-like, coarse, smooth round or oval Benign- vascular, skin, rim-like, coarse, smooth round or oval

BIRADS diagnostic categories BIRADS diagnostic categories  0- need additional testing  1- negative  2- benign finding  3- probably benign finding  4- suspicious  5- highly suggestive of malignancy  6- biopsy proven carcinoma

Limitations of Mammography  Technique and positioning error  Density of breast tissue  Error in reading  Slow growing tumor

Ultrasound  Uses Cystic from solid lesions Cystic from solid lesions U/S guided biopsy U/S guided biopsy  Limitations Not see microcalcification Not see microcalcification Miss part of breast tissue Miss part of breast tissue

Applications of MRI  Screening tool in patients with genetic or familial predisposition  Staging of breast cancer  Determination of recurrent/residual disease  Determination of occult disease

Limitations of MRI  Enhancement during luteal phase  Enhancement with hormone therapy  Difficulty distinguishing benign from malignant  May miss DCIS or invasive lobular

Conclusion  Mammography, ultrasound, and MRI can be used to evaluate breast cancer  Each modality has advantages and limitations  MRI is an evolving diagnostic tool

References  Laura J Esserman, MD, MBA. "Diagnostic evaluation and initial staging work-up of women with suspected breast cancer." Uptodate. 31 May Oct  Mieke Kriege, M.Sc., Cecile T.M. Brekelmans, M.D., Ph.D., Carla Boetes, M.D., Ph.D., Peter E. Besnard, M.D., Ph.D., Harmine M. Zonderland, M.D., Ph.D., Inge Marie Obdeijn, M.D., Radu A. Manoliu, M.D., Ph.D., Theo Kok, M.D., Ph.D. "Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition." Nejm 351 (2004):  Shinil K. Shah, BS, Shiwan K. Shah, BS, and Kathleen V. Greatrex, MD. "Current Role of Magnetic Resonance Imaging in Breast Cancer: A Primer for the Primary Care Physician." JABFM 18 (2005):