This document discusses breast premalignant lesions, their imaging appearance, diagnosis, and management. It provides information on lesions such as DCIS, ADH, ALH, and LCIS. Imaging modalities like mammography, ultrasound, and MRI can detect these lesions as masses, calcifications or other abnormalities. Biopsy is often used for diagnosis but may underestimate the lesion. Surgical excision is generally recommended when premalignant lesions are found on biopsy to rule out associated malignancy, though careful radiologic-pathologic correlation in some cases can guide observation over excision. Underestimation rates vary by biopsy method and number of specimens obtained.
Comparison between mammogram and mri in detecting breast cancernordin1808
MRI mammography is more accurate than mammography in detecting breast diseases. A study compared MRI and mammography on 15 patients and found MRI detected 12 cases of ductal carcinoma in situ (DCIS) in the right breast that mammography missed, as well as 10 cases of DCIS in the left breast. MRI mammography had a sensitivity of 100% while mammography's sensitivity was only 18% for detecting breast cancer. MRI is better able to detect cancers obscured by dense breast tissue and can provide additional information on tumor extent.
The document discusses the evolution of colposcopy terminology and standards. It notes that terminology and techniques vary widely in different settings, making it difficult to compare outcomes and practices. The development of standardized terminology and rigorous training programs, like those in the UK, can help improve colposcopic accuracy and consistency between providers. The document also reviews studies on how factors like lesion size and excision dimensions may impact outcomes. It introduces new terminology for describing findings like the transformation zone type and ridge sign.
2 prof james bently differentiating high and low gradeTariq Mohammed
1) Differentiating between high grade (CIN 2/3) and low grade (CIN 1) cervical lesions is important for treatment decisions.
2) Colposcopic features that suggest high grade lesions include coarse mosaicism, irregular blood vessels, thick opaque white epithelium, well-demarcated ridges, and papillary configurations with sharp borders.
3) Low grade lesions typically have features like a transient whitening with acetic acid, fine punctation, ill-defined margins, and peripheral or small sizes.
This document summarizes the surgical management of the axilla, focusing on sentinel lymph node biopsy techniques. It discusses:
1. The axilla contains 3 levels of lymph nodes that are assessed during axillary surgery. Sentinel lymph node biopsy targets levels I-II.
2. Techniques for identifying sentinel nodes include radioactive tracing using radiocolloids and blue dye mapping. Combined hot and blue methods increase detection rates.
3. Complications of axillary surgery include seroma, lymphedema, infection, and limited arm mobility. Sentinel node biopsy reduces these risks compared to axillary dissection.
4. Ongoing research aims to further minimize the morbidity of axillary staging while
This document summarizes advances in the management of breast cancer over the last 30 years. It discusses trends towards increased use of breast-conserving surgery rather than total mastectomy, as randomized trials have shown equivalent survival outcomes. Sentinel lymph node biopsy has largely replaced axillary lymph node dissection for nodal staging due to lower morbidity. While bilateral mastectomy rates have increased, studies find local recurrence rates remain low with breast-conserving surgery and radiation. Overall, management of breast cancer has shifted to less invasive surgical options due to long-term data demonstrating equivalent survival.
ShearWave™ Elastography in Breast Cancer Patient Management: Clinical Researc...Joel Gay
With 100 peer-reviewed publications, SuperSonic Imagine’s proprietary ShearWave™ Elastography (SWE™) is the most clinically studied shear-wave based elastography for breast lesion characterization.
In this all new webinar, we will walk you through a literature review that will help you to familiarize yourself with clinical research results related to the use of ShearWave™ Elastography (SWE™) within breast ultrasound imaging.
Sentinel Lymph Node Biopsy for Patients with Early Stage Breast Cancer. Updat...Jaime dehais
This guideline from ASCO updates recommendations for the use of sentinel lymph node biopsy (SNB) in patients with early-stage breast cancer based on new evidence. The main recommendations are:
1) Women without sentinel lymph node metastases should not receive axillary lymph node dissection (ALND).
2) Women with one to two metastatic sentinel nodes planning breast-conserving surgery plus radiation should not undergo ALND in most cases.
3) Women with sentinel node metastases who will undergo mastectomy should be offered ALND.
The guideline also makes recommendations regarding the use of SNB in special circumstances like multicentric tumors or prior surgery, and circumstances where SNB is not recommended, based on randomized trials
Comparison between mammogram and mri in detecting breast cancernordin1808
MRI mammography is more accurate than mammography in detecting breast diseases. A study compared MRI and mammography on 15 patients and found MRI detected 12 cases of ductal carcinoma in situ (DCIS) in the right breast that mammography missed, as well as 10 cases of DCIS in the left breast. MRI mammography had a sensitivity of 100% while mammography's sensitivity was only 18% for detecting breast cancer. MRI is better able to detect cancers obscured by dense breast tissue and can provide additional information on tumor extent.
The document discusses the evolution of colposcopy terminology and standards. It notes that terminology and techniques vary widely in different settings, making it difficult to compare outcomes and practices. The development of standardized terminology and rigorous training programs, like those in the UK, can help improve colposcopic accuracy and consistency between providers. The document also reviews studies on how factors like lesion size and excision dimensions may impact outcomes. It introduces new terminology for describing findings like the transformation zone type and ridge sign.
2 prof james bently differentiating high and low gradeTariq Mohammed
1) Differentiating between high grade (CIN 2/3) and low grade (CIN 1) cervical lesions is important for treatment decisions.
2) Colposcopic features that suggest high grade lesions include coarse mosaicism, irregular blood vessels, thick opaque white epithelium, well-demarcated ridges, and papillary configurations with sharp borders.
3) Low grade lesions typically have features like a transient whitening with acetic acid, fine punctation, ill-defined margins, and peripheral or small sizes.
This document summarizes the surgical management of the axilla, focusing on sentinel lymph node biopsy techniques. It discusses:
1. The axilla contains 3 levels of lymph nodes that are assessed during axillary surgery. Sentinel lymph node biopsy targets levels I-II.
2. Techniques for identifying sentinel nodes include radioactive tracing using radiocolloids and blue dye mapping. Combined hot and blue methods increase detection rates.
3. Complications of axillary surgery include seroma, lymphedema, infection, and limited arm mobility. Sentinel node biopsy reduces these risks compared to axillary dissection.
4. Ongoing research aims to further minimize the morbidity of axillary staging while
This document summarizes advances in the management of breast cancer over the last 30 years. It discusses trends towards increased use of breast-conserving surgery rather than total mastectomy, as randomized trials have shown equivalent survival outcomes. Sentinel lymph node biopsy has largely replaced axillary lymph node dissection for nodal staging due to lower morbidity. While bilateral mastectomy rates have increased, studies find local recurrence rates remain low with breast-conserving surgery and radiation. Overall, management of breast cancer has shifted to less invasive surgical options due to long-term data demonstrating equivalent survival.
ShearWave™ Elastography in Breast Cancer Patient Management: Clinical Researc...Joel Gay
With 100 peer-reviewed publications, SuperSonic Imagine’s proprietary ShearWave™ Elastography (SWE™) is the most clinically studied shear-wave based elastography for breast lesion characterization.
In this all new webinar, we will walk you through a literature review that will help you to familiarize yourself with clinical research results related to the use of ShearWave™ Elastography (SWE™) within breast ultrasound imaging.
Sentinel Lymph Node Biopsy for Patients with Early Stage Breast Cancer. Updat...Jaime dehais
This guideline from ASCO updates recommendations for the use of sentinel lymph node biopsy (SNB) in patients with early-stage breast cancer based on new evidence. The main recommendations are:
1) Women without sentinel lymph node metastases should not receive axillary lymph node dissection (ALND).
2) Women with one to two metastatic sentinel nodes planning breast-conserving surgery plus radiation should not undergo ALND in most cases.
3) Women with sentinel node metastases who will undergo mastectomy should be offered ALND.
The guideline also makes recommendations regarding the use of SNB in special circumstances like multicentric tumors or prior surgery, and circumstances where SNB is not recommended, based on randomized trials
Jean Yves Seror : Interventional Senology Diagnostic and therapeutic : State...breastcancerupdatecongress
This document summarizes interventional senology techniques including biopsy methods and their indications, limitations, and complications. It discusses fine needle aspiration biopsy, core needle biopsy, vacuum-assisted biopsy, and percutaneous excisional biopsy. Fine needle aspiration biopsy is well tolerated but has limitations including insufficient samples and inability to assess microcalcifications. Core needle biopsy provides a histological diagnosis but has a risk of underdiagnosis for small or deep lesions. Vacuum-assisted biopsy allows removal of lesions under 8mm with low complication rates but has limitations for complex fibroadenomas or papillary lesions. Percutaneous excision can diagnose and remove lesions but is not feasible for large or deep masses. New techniques aim to remove lesions
This document discusses radioguided surgery techniques used at the Breast Centre of Kwong Wah Hospital, including radioguided occult lesion localization (ROLL) to locate clinically occult breast lesions, and sentinel lymph node biopsy (SLN) to stage breast cancer. It describes the techniques, including injection of radioactive tracers, use of a handheld gamma probe in surgery, and specimen processing. It also covers troubleshooting, sentinel lymph node staging, and radiation protection measures.
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
This document summarizes the classification, pathology, diagnosis, and treatment of ductal carcinoma in situ (DCIS). It discusses the classification of DCIS into different types based on pathology. It describes investigations like mammography, ultrasound, and MRI that are used in the diagnosis of DCIS. It provides details about diagnostic procedures like biopsy. It summarizes several major clinical trials that have evaluated the effectiveness of lumpectomy with and without radiotherapy and adjuvant tamoxifen or anastrozole therapy in treating DCIS.
This document summarizes a study comparing the morbidity of sentinel lymph node biopsy (SLNB) alone versus SLNB followed by completion axillary lymph node dissection for breast cancer. The study found that postoperative morbidity was significantly lower in the SLNB alone group, including less pain, numbness, range of motion issues, and lymphedema. However, intermediate and long-term complications like lymphedema and tumor recurrence rates were equivalent between the groups. The study concludes that while SLNB alone has lower initial morbidity, ALND significantly increases long-term issues like lymphedema and quality of life impacts.
Sentinel lymph node concept in early breast cancer by prof. r. wasikeKesho Conference
This document discusses the sentinel lymph node concept in early breast cancer. It presents three case studies of patients who underwent segmentectomy or breast-conserving therapy along with sentinel lymph node biopsy for early-stage breast cancer tumors. The sentinel lymph node biopsy procedure involves injecting radioactive tracing agents and blue dye to identify the first draining lymph node from the tumor, which is then biopsied to detect any cancer metastases. The sentinel lymph node biopsy procedure provides accurate assessment of axillary node status while avoiding unnecessary full axillary lymph node dissection for most early-stage breast cancer patients.
- Kettering General Hospital Breast Unit went digital between 2010-2012 and implemented tomosynthesis and contrast-enhanced spectral mammography (CESM) to improve cancer detection for women with dense breasts.
- A review of 50 patients who received tomosynthesis found it aided diagnosis in 36 patients (69%), providing extra information in 22 patients and more detailed information in 7 patients.
- A prospective study of 117 CESM exams found it to be as sensitive as MRI in detecting cancer and impacted management for 30% of cancer patients. CESM provided accurate sizing for invasive cancers but was less accurate for lobular cancers and cancers with ductal carcinoma in situ.
1 prof james bently cervical cancer screening 2014Tariq Mohammed
This document discusses options for cervical cancer screening including visual inspection with acetic acid (VIA), cervical cytology, HPV testing, and combinations of tests. It reviews the strengths and limitations of different screening methods and highlights priorities for efficient, low-cost screening in low-resource settings. Optimal screening may involve initial HPV testing at age 35 with reflex cytology for positives and cytology follow-up of negatives before longer interval rescreening.
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
This document discusses breast cancer, including its definition, risk factors, types, staging, diagnosis, and treatment. Breast cancer begins in the breast tissue and may start in the ducts or lobes. It is characterized by uncontrolled cell growth. Some key points:
- Invasive ductal carcinoma is the most common type, accounting for around 80% of cases.
- Staging uses the TNM system to classify tumors by size (T), lymph node involvement (N), and metastasis (M).
- Diagnosis involves clinical examination, imaging like mammography, and biopsy.
- Treatment depends on stage but commonly involves surgery, radiation, chemotherapy, hormone therapy, or a combination.
A review of breast cancer in Saudi Arabia with an update on all aspects of breast cancer management including Diagnosis, Family History, Surgery (& Reconstructive Surgery), Sentinel Node Biopsy and Adjuvant Chemo, Radio and Hormone Therapy.
Regional lymph node management in breast cancerShreya Singh
Regional lymph nodes, including the axillary, supraclavicular, and internal mammary nodes, are important sites of potential breast cancer spread. Axillary ultrasound and sentinel lymph node biopsy help assess lymph node status. Several landmark trials have evaluated the benefits of radiotherapy to regional lymph nodes. The EBCTCG meta-analysis found regional radiotherapy reduced recurrence and breast cancer mortality in patients with 1-3 or 4+ positive lymph nodes. Current guidelines recommend regional radiotherapy for patients with extensive lymph node involvement or other high-risk features.
Spindle cell lesions of the breast diagnostic issues 2019 (1)Alejandro Palacio
This document discusses diagnostic issues with spindle cell lesions of the breast. It proposes a two-step approach for classification and diagnosis. The first step is to determine if the lesion contains both spindle and epithelial components (biphasic) or only spindle cells (monophasic). Biphasic lesions are then graded based on the appearance of the spindle cells. Common biphasic lesions with bland spindle cells include fibroadenoma, benign phyllodes tumor, and pseudoangiomatous stromal hyperplasia (PASH). Accurate diagnosis is important as treatment and prognosis varies between entities. Immunohistochemistry and molecular analysis can aid in distinguishing between lesions.
Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons...breastcancerupdatecongress
This document discusses the use of breast MRI in evaluating response to neoadjuvant chemotherapy. MRI can provide both morphological and functional information about tumors. Studies show DCE-MRI and DWI-MRI may help assess response after 1-2 cycles of chemotherapy, with changes in tumor size, kinetic parameters and ADC values predicting pathological complete or near-complete response. Larger prospective trials are still needed to standardize MRI methods and thresholds to determine if changes on MRI could guide modifications to chemotherapy regimens for non-responders. Overall, MRI shows potential as a predictive marker and non-invasive method for monitoring early response to neoadjuvant breast cancer treatment.
PRIMARY SQUAMOUS CELL CANCER OF BREAST: A CASE REPORTKETAN VAGHOLKAR
Primary squamous cell cancer (SqCC) of the breast is a rather rare disease. These tumors are known to be
quite aggressive in nature and are usually found to be treatment-resistant. Currently, there is no standard treatment
guideline for the management of primary SqCC of the breast. In this case report, we present a case of primary SqCC of
the breast in 60-year old postmenopausal women presenting as pigmented lesion over the right breast (no lump). Initial
skin biopsy (core) done by dermatologist revealed squamous cell cancer in situ (Bowen’s disease); however surgical
resection of the lesion and subsequent histopathological examination revealed primary SqCC (no secondary sites were
found elsewhere in the body).
This study evaluated the sensitivity of breast MRI for detecting breast cancers. Of 222 cancers, MRI correctly identified 213 but missed 9 cancers (sensitivity of 96.8%). The 7 true false-negatives included 4 DCIS lesions and 3 invasive cancers. False-negative lesions were often small or obscured by surrounding enhancing breast tissue. While MRI is highly sensitive for breast cancer, a small percentage of cancers can be missed, particularly DCIS and cancers in a background of diffuse parenchymal enhancement.
Endometrial cancer starts when cells in the inner lining of the uterus grow abnormally and can spread. Some key risk factors include excess estrogen exposure without progesterone opposition, obesity, late menopause, and family history. Common symptoms are abnormal vaginal bleeding or discharge. Diagnosis involves endometrial biopsy and other imaging tests. Treatment options include surgery to remove the uterus and surrounding tissue, radiation therapy, chemotherapy, hormone therapy, and targeted therapies. The cancer is staged based on how much it has spread in the body.
Luc Rotenberg : US guided vacuum breast biopsy and minimal Invasive Intervent...breastcancerupdatecongress
This document summarizes minimal invasive interventional procedures for breast lesions. It discusses ultrasound-guided breast biopsy procedures and whether they can provide minimal invasive diagnosis and treatment of benign and malignant lesions. Various biopsy methods and devices are reviewed, including vacuum-assisted biopsy. Indications, risks, sample size, and follow up after biopsy are addressed. Underestimation rates of ductal carcinoma in situ and atypical lesions with biopsy are discussed. Radiological-pathological concordance and determining appropriate management of biopsy results is also covered. Radiofrequency ablation is presented as a potential minimal invasive treatment option.
This document provides information about the management of breast cancer. It discusses the worldwide incidence rates of breast cancer, with the highest rates in North America and Western Europe. It outlines the process of cancer control, including early detection, diagnosis, primary prevention, and treatment. The document then discusses signs and symptoms of breast cancer, the diagnosis process, staging classifications, and treatments such as lumpectomy versus mastectomy. It provides data on breast cancer incidence rates in Egypt compared to other regions. Overall, the document provides an overview of breast cancer management, diagnosis, and treatment approaches on a global and national level in Egypt.
Comparison between mammogram and mri in detecting breast cancernordin1808
MRI mammography is more accurate than mammography in detecting breast diseases. A study compared MRI and mammography on 15 patients and found MRI detected 12 cases of ductal carcinoma in situ (DCIS) in the right breast that mammography missed, and 10 cases of DCIS in the left breast that mammography also missed. MRI mammography had a sensitivity of 100% while mammography's sensitivity was only 18% in detecting breast cancers. MRI is better able to detect lesions obscured by dense breast tissue and can find additional, missed tumors in the other breast of cancer patients. However, further large-scale studies are still needed to continue validating MRI mammography.
Jean Yves Seror : Interventional Senology Diagnostic and therapeutic : State...breastcancerupdatecongress
This document summarizes interventional senology techniques including biopsy methods and their indications, limitations, and complications. It discusses fine needle aspiration biopsy, core needle biopsy, vacuum-assisted biopsy, and percutaneous excisional biopsy. Fine needle aspiration biopsy is well tolerated but has limitations including insufficient samples and inability to assess microcalcifications. Core needle biopsy provides a histological diagnosis but has a risk of underdiagnosis for small or deep lesions. Vacuum-assisted biopsy allows removal of lesions under 8mm with low complication rates but has limitations for complex fibroadenomas or papillary lesions. Percutaneous excision can diagnose and remove lesions but is not feasible for large or deep masses. New techniques aim to remove lesions
This document discusses radioguided surgery techniques used at the Breast Centre of Kwong Wah Hospital, including radioguided occult lesion localization (ROLL) to locate clinically occult breast lesions, and sentinel lymph node biopsy (SLN) to stage breast cancer. It describes the techniques, including injection of radioactive tracers, use of a handheld gamma probe in surgery, and specimen processing. It also covers troubleshooting, sentinel lymph node staging, and radiation protection measures.
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
This document summarizes the classification, pathology, diagnosis, and treatment of ductal carcinoma in situ (DCIS). It discusses the classification of DCIS into different types based on pathology. It describes investigations like mammography, ultrasound, and MRI that are used in the diagnosis of DCIS. It provides details about diagnostic procedures like biopsy. It summarizes several major clinical trials that have evaluated the effectiveness of lumpectomy with and without radiotherapy and adjuvant tamoxifen or anastrozole therapy in treating DCIS.
This document summarizes a study comparing the morbidity of sentinel lymph node biopsy (SLNB) alone versus SLNB followed by completion axillary lymph node dissection for breast cancer. The study found that postoperative morbidity was significantly lower in the SLNB alone group, including less pain, numbness, range of motion issues, and lymphedema. However, intermediate and long-term complications like lymphedema and tumor recurrence rates were equivalent between the groups. The study concludes that while SLNB alone has lower initial morbidity, ALND significantly increases long-term issues like lymphedema and quality of life impacts.
Sentinel lymph node concept in early breast cancer by prof. r. wasikeKesho Conference
This document discusses the sentinel lymph node concept in early breast cancer. It presents three case studies of patients who underwent segmentectomy or breast-conserving therapy along with sentinel lymph node biopsy for early-stage breast cancer tumors. The sentinel lymph node biopsy procedure involves injecting radioactive tracing agents and blue dye to identify the first draining lymph node from the tumor, which is then biopsied to detect any cancer metastases. The sentinel lymph node biopsy procedure provides accurate assessment of axillary node status while avoiding unnecessary full axillary lymph node dissection for most early-stage breast cancer patients.
- Kettering General Hospital Breast Unit went digital between 2010-2012 and implemented tomosynthesis and contrast-enhanced spectral mammography (CESM) to improve cancer detection for women with dense breasts.
- A review of 50 patients who received tomosynthesis found it aided diagnosis in 36 patients (69%), providing extra information in 22 patients and more detailed information in 7 patients.
- A prospective study of 117 CESM exams found it to be as sensitive as MRI in detecting cancer and impacted management for 30% of cancer patients. CESM provided accurate sizing for invasive cancers but was less accurate for lobular cancers and cancers with ductal carcinoma in situ.
1 prof james bently cervical cancer screening 2014Tariq Mohammed
This document discusses options for cervical cancer screening including visual inspection with acetic acid (VIA), cervical cytology, HPV testing, and combinations of tests. It reviews the strengths and limitations of different screening methods and highlights priorities for efficient, low-cost screening in low-resource settings. Optimal screening may involve initial HPV testing at age 35 with reflex cytology for positives and cytology follow-up of negatives before longer interval rescreening.
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
This document discusses breast cancer, including its definition, risk factors, types, staging, diagnosis, and treatment. Breast cancer begins in the breast tissue and may start in the ducts or lobes. It is characterized by uncontrolled cell growth. Some key points:
- Invasive ductal carcinoma is the most common type, accounting for around 80% of cases.
- Staging uses the TNM system to classify tumors by size (T), lymph node involvement (N), and metastasis (M).
- Diagnosis involves clinical examination, imaging like mammography, and biopsy.
- Treatment depends on stage but commonly involves surgery, radiation, chemotherapy, hormone therapy, or a combination.
A review of breast cancer in Saudi Arabia with an update on all aspects of breast cancer management including Diagnosis, Family History, Surgery (& Reconstructive Surgery), Sentinel Node Biopsy and Adjuvant Chemo, Radio and Hormone Therapy.
Regional lymph node management in breast cancerShreya Singh
Regional lymph nodes, including the axillary, supraclavicular, and internal mammary nodes, are important sites of potential breast cancer spread. Axillary ultrasound and sentinel lymph node biopsy help assess lymph node status. Several landmark trials have evaluated the benefits of radiotherapy to regional lymph nodes. The EBCTCG meta-analysis found regional radiotherapy reduced recurrence and breast cancer mortality in patients with 1-3 or 4+ positive lymph nodes. Current guidelines recommend regional radiotherapy for patients with extensive lymph node involvement or other high-risk features.
Spindle cell lesions of the breast diagnostic issues 2019 (1)Alejandro Palacio
This document discusses diagnostic issues with spindle cell lesions of the breast. It proposes a two-step approach for classification and diagnosis. The first step is to determine if the lesion contains both spindle and epithelial components (biphasic) or only spindle cells (monophasic). Biphasic lesions are then graded based on the appearance of the spindle cells. Common biphasic lesions with bland spindle cells include fibroadenoma, benign phyllodes tumor, and pseudoangiomatous stromal hyperplasia (PASH). Accurate diagnosis is important as treatment and prognosis varies between entities. Immunohistochemistry and molecular analysis can aid in distinguishing between lesions.
Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons...breastcancerupdatecongress
This document discusses the use of breast MRI in evaluating response to neoadjuvant chemotherapy. MRI can provide both morphological and functional information about tumors. Studies show DCE-MRI and DWI-MRI may help assess response after 1-2 cycles of chemotherapy, with changes in tumor size, kinetic parameters and ADC values predicting pathological complete or near-complete response. Larger prospective trials are still needed to standardize MRI methods and thresholds to determine if changes on MRI could guide modifications to chemotherapy regimens for non-responders. Overall, MRI shows potential as a predictive marker and non-invasive method for monitoring early response to neoadjuvant breast cancer treatment.
PRIMARY SQUAMOUS CELL CANCER OF BREAST: A CASE REPORTKETAN VAGHOLKAR
Primary squamous cell cancer (SqCC) of the breast is a rather rare disease. These tumors are known to be
quite aggressive in nature and are usually found to be treatment-resistant. Currently, there is no standard treatment
guideline for the management of primary SqCC of the breast. In this case report, we present a case of primary SqCC of
the breast in 60-year old postmenopausal women presenting as pigmented lesion over the right breast (no lump). Initial
skin biopsy (core) done by dermatologist revealed squamous cell cancer in situ (Bowen’s disease); however surgical
resection of the lesion and subsequent histopathological examination revealed primary SqCC (no secondary sites were
found elsewhere in the body).
This study evaluated the sensitivity of breast MRI for detecting breast cancers. Of 222 cancers, MRI correctly identified 213 but missed 9 cancers (sensitivity of 96.8%). The 7 true false-negatives included 4 DCIS lesions and 3 invasive cancers. False-negative lesions were often small or obscured by surrounding enhancing breast tissue. While MRI is highly sensitive for breast cancer, a small percentage of cancers can be missed, particularly DCIS and cancers in a background of diffuse parenchymal enhancement.
Endometrial cancer starts when cells in the inner lining of the uterus grow abnormally and can spread. Some key risk factors include excess estrogen exposure without progesterone opposition, obesity, late menopause, and family history. Common symptoms are abnormal vaginal bleeding or discharge. Diagnosis involves endometrial biopsy and other imaging tests. Treatment options include surgery to remove the uterus and surrounding tissue, radiation therapy, chemotherapy, hormone therapy, and targeted therapies. The cancer is staged based on how much it has spread in the body.
Luc Rotenberg : US guided vacuum breast biopsy and minimal Invasive Intervent...breastcancerupdatecongress
This document summarizes minimal invasive interventional procedures for breast lesions. It discusses ultrasound-guided breast biopsy procedures and whether they can provide minimal invasive diagnosis and treatment of benign and malignant lesions. Various biopsy methods and devices are reviewed, including vacuum-assisted biopsy. Indications, risks, sample size, and follow up after biopsy are addressed. Underestimation rates of ductal carcinoma in situ and atypical lesions with biopsy are discussed. Radiological-pathological concordance and determining appropriate management of biopsy results is also covered. Radiofrequency ablation is presented as a potential minimal invasive treatment option.
This document provides information about the management of breast cancer. It discusses the worldwide incidence rates of breast cancer, with the highest rates in North America and Western Europe. It outlines the process of cancer control, including early detection, diagnosis, primary prevention, and treatment. The document then discusses signs and symptoms of breast cancer, the diagnosis process, staging classifications, and treatments such as lumpectomy versus mastectomy. It provides data on breast cancer incidence rates in Egypt compared to other regions. Overall, the document provides an overview of breast cancer management, diagnosis, and treatment approaches on a global and national level in Egypt.
Comparison between mammogram and mri in detecting breast cancernordin1808
MRI mammography is more accurate than mammography in detecting breast diseases. A study compared MRI and mammography on 15 patients and found MRI detected 12 cases of ductal carcinoma in situ (DCIS) in the right breast that mammography missed, and 10 cases of DCIS in the left breast that mammography also missed. MRI mammography had a sensitivity of 100% while mammography's sensitivity was only 18% in detecting breast cancers. MRI is better able to detect lesions obscured by dense breast tissue and can find additional, missed tumors in the other breast of cancer patients. However, further large-scale studies are still needed to continue validating MRI mammography.
3.Edward A. Sickles_Surveillance Imaging for Probably Benign Findings: Benefi...Wanfang Radiology
This document summarizes evidence on mammographic surveillance of probably benign breast lesions. Key points include:
- Studies have found positive predictive values of 0.1-11.2% for probably benign lesions identified on mammography and followed with serial imaging.
- Cancers detected through surveillance tend to be nonpalpable, early-stage lesions with favorable prognosis despite interval growth.
- Serial imaging can help identify cancers earlier through detection of interval change in probably benign lesions over time.
This document provides guidelines for managing abnormal Pap smears, cervical dysplasia, and cervical cancer. It discusses evaluating Pap test results using the Bethesda system and determining appropriate follow up. It also outlines treatment options for cervical dysplasia like cryotherapy, LEEP, and cone biopsy. For invasive cervical cancer, it describes staging and evaluating and treating the disease in consultation with a gynecologic oncologist.
Breast cancer screening-2021 chan hio tongjim kuok
This document discusses breast cancer screening and provides guidance on screening strategies based on risk level. It covers:
1) Screening modalities like mammography, ultrasound, MRI and their limitations. Mammography is the primary screening tool for average risk women aged 50-74.
2) Risk assessment factors like family history, genetic mutations, breast density, reproductive history which determine screening frequency and additional tests. Women at high risk start screening earlier and more frequently.
3) Two case studies where mammography limitations are demonstrated. Early detection through clinical exams and additional tests led to cancer diagnosis in both cases. Regular screening tailored to risk level can improve early detection.
Adenocarcinoma in situ (AIS) is the only known precursor to cervical adenocarcinoma. Appropriate management of AIS can prevent invasive adenocarcinoma in many cases. Cytology has lower sensitivity for detecting AIS compared to HPV testing. The usual interval between detectable AIS and invasive adenocarcinoma is at least 5 years, allowing time for screening and intervention. Glandular neoplasms account for about 25% of annual cervical cancer diagnoses. Management of AIS typically involves conization, though hysterectomy is the standard treatment due to the high risk of residual disease with conization alone. HPV testing can help monitor women with AIS who wish to preserve fertility after
Male breast cancer is rare, accounting for less than 1% of breast cancers. Risk factors include Klinefelter syndrome, genetic mutations like BRCA2, and family history. Treatment typically involves mastectomy with lymph node dissection and tamoxifen therapy. Occult breast cancer presents as axillary lymph node metastases without a detectable primary tumor. Further workup with imaging and biopsy is needed. Standard treatment is axillary lymph node dissection along with mastectomy or radiation therapy to the breast. Prognosis depends on stage but can be similar to typical breast cancer outcomes with proper treatment.
This study examined 51 patients who were diagnosed with atypical ductal hyperplasia (ADH) on breast biopsy and then underwent surgical excision. The study found that 17 patients (33%) had ductal carcinoma in situ or invasive cancer identified on final surgical pathology. Only the grade of atypia seen on the initial biopsy was found to significantly predict the finding of cancer on excision, with a higher grade of atypia correlating with a higher likelihood of cancer being present. Specifically, 75% of patients with marked atypia on biopsy were found to have cancer on excision, compared to 18% of patients with moderate atypia and 0% of patients with mild atypia. The study concludes that
Breast cancer screening guidelines recommend biennial mammography for women aged 50-74 in well-resourced settings, as it can reduce breast cancer mortality by around 16% compared to no screening. For limited-resource settings, the guidelines conditionally recommend clinical breast examination as a low-cost alternative. Screening intervals of less than 24 months show no added benefit over longer intervals. Shared decision making around risks of false positives and overdiagnosis is important. Early diagnosis through awareness and symptom screening is prioritized where most women present at late stages due to weak health systems.
2012 Project design of an Integrated Well Woman Clinic combining a Women's Health assessment with Screening and Early Diagnosis of Breast and Gynecological Cancers
Womans Cancer Foundation, Well Woman ClinicMaheshShettyMD
A suggested model for a Well Woman Examination combined with Screening and Early diagnosis methods for Breast and Gynecological Cancers in developing countries proposed by Woman's Cancer Foundation, USA. www.womanscancerfoundation.org
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L rotenberg, g lenczner premalignant breast lesion imaging jfim hanoi 2015 comp
1. !
Breast Premalignant lesions
imaging
diagnosis & interventional
Luc Rotenberg, Gregory Lenczner,
Jean Guigui, Catherine Beges, Mehdi Cadi
RPO – ISHH
Clinique Hartmann-CMC Ambroise Paré
26-27 bdVictor Hugo
92200 Neuilly Sur Seine - France
dr.rotenberg@radiologieparisouest.com
Du 5 au 8 nov 2015 / from nov 5th to 8th 2015
14è Edition Hanoï - Vietnam
2. !
Hard and spiculated = malignant ? Smooth and regular = benign ?
Conventional Wisdom in Breast imaging
4. !
Premalignant lesions imaging
DCIS, ADH, ALH, LCIS…
S Screening, detection or diagnosis :
S Mammography
S Full Digital Mammography
S 3D Digital Breast Tomosynthesis - DBT
S Sonography
S High frequency probe
S Doppler
S elastography
S MRI
S 1,5 or 3T magnet
S Morphologic and dynamic study, perfusion
S Diffusion
S Spectroscopy-MRI
S Goal = evaluation for a risk : BIRADS classification
S No specifity for premalignant lesion
PML prevalence out of DCIS
ADH 5 %
ALH/LCIS 0,9 to 2 %
5. !
Premalignant lesions imaging
DCIS, ADH, ALH, LCIS…
S Histological diagnosis by the pathologist always
mandatory
S No histological diagnosis on imaging !
S However, diagnostic hypotheses and indications of
action to be taken are welcome
6. !
Premalignant lesions imaging
DCIS, ADH, ALH, LCIS…
S All imaging pattern can be found
associated with PML
S Mass
S Mass with calcifications
S µcalcifications
S No mass lesion :
S focal density, desorganisation, ehancement
7. !
Breast Cancer Risk Factors
Risk Factor Min Max x
LCIS on biopsy 1.00 8.70 8.70
No. 1st degree relatives with breast cancer 1.00 6.80 6.80
Mammographic density 0.41 1.76 4.29
No. of biopsies 1.00 2.88 2.88
Tamoxifen 0.45 1.00 2.22
Biopsy with atypical hyperplasia 0.93 1.82 1.96
Oral contraceptives / Menop Horm Therapy 1.00 1.49 1.49
Alcohol use / Obesity 0.99 1.41 1.42
Early menarche / late menopause 1.00 1.21 1.21
From http://www.halls.md/breast/gailmods.htm
8. !
Unusual breast lesion?
S Patient
S High risk, young, anxious…
S Imaging pattern
S Location
S Pathologic findings
Unusual, uncommon, bizarre, strange or exceptional
is our daily work and practice
every patient is unique
10. !
Birads 1 screening
Birads 2 screening
Birads 3 Follow up except high risk
Birads 4 a
Follow up except
progressive or high risk
Birads 4 b,c
LCB or VABB
diagnosis
Birads 5/6
LCB or VABB
diagnosis ou stategical
11. !
Probably benign
malignancy 0,2 à 5%
§ Follow up
§ No biopsy indication excepted for :
§ High risk patient
§ BRCA mutation
§ synchronous cancer
§ Impossible follow up
§ Cancerophobia
Bi-Rads 3
14. !
Very suspicious lesion for
malignancy
§ fine needle aspiration : no
more or sentinal lymph
nodes
§ Core biopsy 16 or 14 G
§ histology, HR, Her2...
§ Suspicious for recidive
§ after surgery
§ after radiotherapy
Bi-Rads 5 to 6
15. !
Birads 5
Strategical indications
1. Before surgery & sentinel
lymph node technique
2. Before surgery for extended
DCIS (mastectomy)
3. Multicentric and bilateral
lesion
Bi-Rads 5 to 6
34. !
DCIS
Roger J. Jackman & al, Radiology February 2001 218:497-502
Stereotactic Breast Biopsy of Nonpalpable Lesions: Determinants of
Ductal Carcinoma in Situ Underestimation Rates
S DCIS underestimation rates by biopsy device were
S 20.4% (76 of 373) at large-core biopsy
S 11.2% (107 of 953) at vacuum-assisted biopsy (P < .001)
S 24.3% (35 of 144) of masses
S 12.5% (148 of 1,182) of microcalcifications (P < .001)
S and by number of specimens per lesion
S 17.5% (88 of 502) with 10 or fewer specimens
S 11.5% (92 of 799) with greater than 10 (P < .02).
S DCIS underestimations increased with lesion size
1.9 times more frequent with masses
than with calcifications
1.8 times more frequent with LCB than
with VAB
1.5 times more frequent <10 or fewer
specimens per lesion than with ≥ 10
specimens per lesion.
35. !
Frederick R. Margolin1 Jessica W. T. Leung1,2 Richard P. Jacobs1 Susan R. Denny1
Percutaneous Imaging-Guided Core Breast Biopsy: 5 Years’ Experience in a Community
Hospital, AJR:177, September 2001
ADH
36. !
Peter R. Eby, Jennifer E. Ochsner, Wendy B. DeMartini & al, Frequency and Upgrade Rates of
Atypical Ductal Hyperplasia Diagnosed at Stereotactic Vacuum-Assisted Breast Biopsy: 9-
Versus 11-Gauge. AJR 2009; 192:229–234
ADH
37. !
ADH Prevalence
RJ Jackman, RL Birdwell, DM Ikeda, Atypical Ductal Hyperplasia: Can Some Lesions Be
Defined as Probably Benign after Stereotactic 11-gauge Vacuum- assisted Biopsy,
Eliminating the Recommendation for surgical exision ? Radiology 2002; 224:548–554
38. !
Radial Scars
R. James Brenner, Roger J. Jackman, Steve H. Parker & al, Percutaneous Core Needle Biopsy
of Radial Scars of the Breast: When Is Excision Necessary? AJR:179, November 2002
S Carcinoma was found at excision in
S 28% (8/29) of lesions with associated atypical hyperplasia
S 4% (5/128) of lesions without associated atypia
S In the latter group, carcinoma was found at excision in
S 3% (2/60) of masse
S 8% (3/40) of architectural distortions
S 0% (0/28) of microcalcification lesions
S Malignancy was missed in
S 9% (5/58) of lesions biopsied with a spring-loaded device LCB
S 0% (0/70) of lesions biopsied with a directional vacuum-assisted device VABB
S 8% (5/60) of lesions sampled with less than 12 specimens
S 0% (0/68) sampled with 12 or more specimens
S Lesion type, maximal lesion diameter, and type of imaging guidance (stereotactic or sonographic) were not significant factors in determining the
presence of malignancy
S CONCLUSION: Diagnosis of radial scar based on core needle biopsy is likely to be reliable when
S no associated atypical hyperplasia
S biopsy includes at least 12 specimens (VABB)
S mammographic findings are reconciled with histologic findings.
S If miss a criteria, excisional biopsy is indicated
39. !
Lobular Neoplasia : ALH & LCIS
at Percutaneous Breast Biopsy: Variables Associated with Carcinoma at Surgical Excision
Rachel F. Brem, Mary C. Lechner, Roger J. Jackman
AJR 2008; 190:637–641
S OBJECTIVE. better define the rate and variables associated with cancer underestimation when lobular
neoplasia is found at breast biopsy. ALH or LCIS
S MATERIALS AND METHODS.
S The records of 32,420 patients who underwent imaging- guided needle biopsy from 1988 to 2000
retrospectively reviewed.
S 278 cases in which lobular neoplasia was the highest-risk lesion at biopsy were included.
S 164 proceeded to surgical excision, allowing calculation of rates of underestimation from minimally
invasive biopsy.
S RESULTS
S lobular neoplasia was found in 278 = 0.9%
S 164/278 (59%) continued to surgical excision
S cancer confirmed in 38 = 23%
S No difference underestimation rates LCIS = 25%, 17 of 67 / ALH = 22%, 21 of 97 lesions
S Statistically significant underestimation
S masses (with or without associated µcalcifications) > µcalcifications only
S higher BI-RADS category
S core biopsy device rather than a vacuum device
S obtaining fewer specimens
S CONCLUSION
S all patients with lobular neoplasia at core or vacuum-assisted biopsy should
undergo surgical excision until further differentiating criteria can be
determined.
40. !
Lobular carcinoma in situ/atypical lobular hyperplasia on breast needle
biopsies: does it warrant surgical excisional biopsy? A study of 27 cases
O’Neil M, Madan R, Tawfik OW, Thomas PA, Fan F. Ann Diagn Pathol 2010;14(4):251–255
S 3163 breast core needle biopsies were retrieved from the surgical pathology files between 2003 and 2009
S among them, 56 (1.8%) cases were identified with a diagnosis of ALH or LCIS
S Eleven cases were excluded because of the presence of a concurrent more severe lesion in the biopsies
that mandated excision
S The remaining 45 cases contained only ALH or LCIS
S 27 had surgical excision follow-up
S In the surgical excision specimens, 5 (19%) of 27 (11% of 45) cases showed more severe lesions or
were "upgraded »
S 3 invasive ductal carcinomas
S 1 invasive lobular carcinoma
S 1 ductal carcinoma in situ
S Histologic features of the lobular neoplasia on the core were found to have no predictive value for
a more severe lesion in the subsequent excision
S We suggest that patients with LCIS/ALH on core needle biopsy should be considered for
surgical excision to rule out a more significant lesion regardless of the histologic features.
41. !
Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast Biopsy:
Use of Careful Radiologic-Pathologic Correlation to Recommend Excision or
Observation
Kristen A. Atkins, Michael A. Cohen, Brandi Nicholson, Sandra Rao.
Northwestern Memorial Hospital, Prentice Women’s Hospital, Chicago.
Radiology, 2013, Vol.269: 340-347, 10.1148/radiol.13121730
Flow diagram of total number of cases partitioned into radiologic and histologic concordance or discordance. IC = invasive carcinoma.
42. !
Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast Biopsy:
Use of Careful Radiologic-Pathologic Correlation to Recommend Excision or
Observation
Kristen A. Atkins, Michael A. Cohen, Brandi Nicholson, Sandra Rao.
Northwestern Memorial Hospital, Prentice Women’s Hospital, Chicago.
Radiology, 2013, Vol.269: 340-347, 10.1148/radiol.13121730
S Advance in Knowledge
S When careful radiologic-pathologic correlation is conducted in the setting of a
breast core biopsy with atypical lobular hyperplasia or lobular carcinoma in situ
some women can be safely triaged to observation
S of the 43 benign concordant cases, none were upgraded at
surgery or extended follow-up
S Implication for Patient Care
S Focused and complete radiologic-pathologic correlation may
obviate excisional biopsy in patients with benign concordant biopsy
findings
S Additional validation of this is required before this approach can be
universally applied
• None of the 43 (95% CI: 0%, 8%) benign concordant cases were
upgraded at subsequent surgical excision or extended imaging
follow-up
• which suggests that arbitrary excision in all cases of ALH or LCIS
may not be necessary.
43. !
Discussion
to excise or to sample ?
— Excision for probably benign
lesion + clip
S Birads 3
S Birads 4a
— Sample for suspicious or
malignant lesion
S Birads 4 b & c
S Birads 5 & 6
48. !
S No imaging specificity for PML
S Histology correlation for all Birads 4 and 5 lesions
S PML prevalence out of DCIS
S ADH 5 %
S ALH/LCIS 0,9 to 2 %
S Under-estimation rate
S ≈ 10 % VABB
S ≈ 20 % LCNB
S PML refered for surgical excision
S ALH ?...
S Present & Next Futur :
S Minimal invasive therapy/ patient selection
S Benign
S Premalignant and Malignant ?
Take home message