S taieb advanced breast lesion imaging jfim hanoi 2015
•
0 likes•380 views
This document discusses imaging techniques for assessing the size of advanced breast lesions over 5 cm. Studies have shown ultrasound generally overestimates size compared to mammography but is more accurate than physical examination alone. MRI has shown the strongest correlation to pathological tumor size, followed by tomosynthesis, mammography, and ultrasound. Assessing size accurately is important for surgical planning of large breast cancers.
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (11)
Similar to S taieb advanced breast lesion imaging jfim hanoi 2015
Similar to S taieb advanced breast lesion imaging jfim hanoi 2015 (20)
More from JFIM - Journées Francophones d'Imagerie Médicale
More from JFIM - Journées Francophones d'Imagerie Médicale (20)
Recently uploaded
Recently uploaded (20)
S taieb advanced breast lesion imaging jfim hanoi 2015
- 1. Imagerie des lésions localement avancées Advanced breast lesion imaging. S. Taïeb, A.Mailliez, H.Gauthier, S.Giard, L.Ceugnart Hanoi, 6 nov 2015
- 2. Advanced breast lesions : > 5 cm
- 5. 1st step : Tumor Size -‐ > 5cm CorrelaEng sonography, mammography, and pathology in the assessment of breast cancer size. § Hieken et al. Am J Surg. 2001 -‐ ü 180 à 146 invasive tumors mammo & US ü 69% size US > mammo with equivalent underesEmaEon / pathology ü Maximal tumor dimension accurate 75% US / 65% mammo
- 6. 1st step : Tumor Size -‐ > 5cm CorrelaEng sonography, mammography, and pathology in the assessment of breast cancer size. § Hieken et al. Am J Surg. 2001 -‐ ü 180 à 146 invasive tumors mammo & US ü 69% size US > mammo with equivalent underesEmaEon / pathology ü Maximal tumor dimension accurate 75% US / 65% mammo § Bosch et al. Eur J Radiol 2003 (+ Physical examinaEon) ü 105 à 73 invasive tumors mammo & US ü CorrelaEon coefficient : US 0,68; Mammo 0,44; PE 0,42 ü PE : overesEmaEon; US : underesEmaEon
- 7. 1st step : Tumor Size -‐ > 5cm CorrelaEng sonography, mammography, and pathology in the assessment of breast cancer size. § Hieken et al. Am J Surg. 2001 -‐ ü 180 à 146 invasive tumors mammo & US ü 69% size US > mammo with equivalent underesEmaEon / pathology ü Maximal tumor dimension accurate 75% US / 65% mammo § Bosch et al. Eur J Radiol 2003 (+ Physical examinaEon) ü 105 à 73 invasive tumors mammo & US ü CorrelaEon coefficient : US 0,68; Mammo 0,44; PE 0,42 ü PE : overesEmaEon; US : underesEmaEon US > Mammographie CI 95% : +/-‐ 11 mm
- 8. 48 ans, PE : Mass 5cm,
- 9. 48 ans, PE : Mass 5cm, Mammo : 7cm
- 10. US Biopsy 11h, 4cm : CCI 48 ans, PE : Mass 5cm, Mammo : 7cm US 21 mm
- 11. Macrobiopsy 12 h : CCIS grade 3. Macrobiopsy 2 h : CCIS grade 2 & 3 48 ans, PE : Mass 5cm, Mammo : 7cm US 21 mm
- 12. § Totale Mastectomy : CCI 15 mm + CCIS 7 cm Ki67 : 10 % RO+ (70 % Score = 5) RP-‐ (2 % Score = 1) HER2 = 3+, fort § SLN : 10N-‐ / 10N
- 13. 56 y-‐o, PE : Mass 4 cm,
- 14. 56 y-‐o, PE : Mass 4 cm, Mammo ?
- 15. 56 y-‐o, PE : Mass 4 cm, Mammo ? US : 32 mm
- 16. 56 y-‐o, PE : Mass 4 cm, Mammo ? US : 32 mm MRI : 20 x 19 mm CLI : 28 x 22 mm
- 17. 33 y-‐o, PE : Mass 4 cm, Mammo 2 cm
- 18. 33 y-‐o, PE : Mass 4 cm, Mammo 2 cm US : 4 cm
- 19. 33 y-‐o, PE : Mass 4 cm, Mammo 2 cm US : 4 cm
- 20. 33 y-‐o, PE : Mass 3 cm, Mammo 3 cm US : 40 mm MRI : 35 / 49 ?
- 21. 33 y-‐o, PE : Mass 3 cm, Mammo 3 cm US : 40 mm MRI : 35 / 49 ? CCI grade II, 37 mm ER-‐, ErP -‐, Her2 -‐, KI67 20%
- 22. 1st step : Tumor Size -‐ > 5cm § Luparia et al. Radiol Med. 2013 : CorrelaEng Sonography, Mammography, Tomosynthesis, MRI and pathology in the assessment of breast cancer size. ü 149 lesions / 110 paEents – 22,3mm ü CorrelaEon with pathological tumor size • MRI : 0,92 -‐ TS : 0,89 • DM : 0,83 -‐ US : 0,77 § Jethava et al. Conn Med 2015 : MRI and histological size ü 147 lesions / 124 paEents – 81 IDC, 35 DCIS, 15 ILC, 16 others ü Concordance 5 mm 56% ü OveresEmaEon : 32% -‐ High grade tumor and CCIS ü UnderesEmaEon : 12% MRI > US > Mammography > PE
- 23. § 33 pts, 37 lesions : 27 DIC, 10 LIC. § MRI and Gross specimen / Microscopic size Behjatnia b et al. Int J Clin Exp Pathol 2010
- 24. § 33 pts, 37 lesions : 27 DIC, 10 LIC. § MRI and Gross specimen / Microscopic size Behjatnia b et al. Int J Clin Exp Pathol 2010
- 25. § 33 pts, 37 lesions : 27 DIC, 10 LIC. § MRI and Gross specimen / Microscopic size Behjatnia b et al. Int J Clin Exp Pathol 2010 Although MRI is the most accurate modality we have to image the breast so far, it remains imperfect : § OveresEmaEng tumor size in 11% to 70% of paEents, § UnderesEmaEng it in 10% to 56% of paEents.
- 26. Tumor Size -‐ > 5cm but not only § MRI à § US à § Mammo à § ER, PgR ? § HER 2 ? § Ki67 ?
- 27. St Gallen Conference 2015 & ESMO 2015
- 28. Advanced breast lesion § Mastectomy : ü Progressive disease with chemotherapy ü Contra indicaEon for radiotherapy ü PosiEve tumor margins with no possibility of new resecEon ü PaEent decision § Mastectomy or neoadjuvant chemotherapy ? ü Lesion > 5 cm ü Size tumor raEo / size breast < 1/4 § Neoadjuvant chemotherapy : Inflammatory breast cancer § Mastectomy or oncoplasty ? MulEfocal breast cancer
- 29. Inflammatory breast cancer § 1-‐5% § PEV 0 : same volume § PEV 1 : x2 in 6 months § PEV 2 : focal form § PEV3 : Diffuse form (masEEs carcinomatosa) § Very poor prognosis § Neoadjuvant chemotherapy always
- 30. DescripEon 45 – 55 y-‐o Few weeks : § Redness, edema > 1/3 of the breast § Nipple retracEon § Orange-‐peel appearance of the skin § Pain PE : § Mass 60%, § Axillary LN > 50% § No fever
- 32. US § Skin thickening § Edema § Focal mass and distorsion § Involved regional lymph nodes
- 34. 42 y-‐o 3 weeks
- 35. US : no mass à MRI
- 36. MRI
- 37. Inflammatory breast cancer : diagnosis § Skin punch biopsy : lymphovascular embols § US biopsy if mass § Vacuum-‐Assisted core biopsy if microcalcificaEon Courtesy S.Morand
- 38. MulEfocal breast cancer 42 y-‐o, PE : leq axillary lymph node N+ Courtesy I.Thomassin
- 40. US : 2 lesions + LN
- 41. MRI : 3 lesions / 5 cm
- 42. 2nd step : Lymph nodes Houssami N et al. PreoperaEve ultrasound-‐guided needle biopsy of axillary nodes in invasive breast cancer: meta-‐analysis of its accuracy and uElity in staging the axilla. Ann Surg. 2011 ü 1965-‐2011 : 125 studies , 2874 US guided biopsy / 6166 femmes ü Se : 80%, Sp : 98% -‐ palpable or not -‐ FNB / CNB -‐ Prevalence N+ in studies
- 44. 3rd step : M ? ESMO 2015 : addiEonal invesEgaEons should be considered : § N+ § T > 5 cm § Agressive biology § Symptoms or laboratory values suggesEng M+ § CT : Chest + Abdomen + Pelvis with bone analysis § FDG-‐PET/CT may be useful ü Inconclusive CT ü Follow-‐up neoadjuvant chemotherapy
- 46. § N3 in 32 paEents § M1 in 43 paEents / PET-‐ CT; 28 / ConvenEonal Imaging § PET-‐CT > CT : bone metastasis, extra-‐axillary lymph nodes and liver metastasis § CT (98,3%) > PET-‐CT (97,4%) for lung metastasis § PET-‐CT (98,3%) > Bone scan (89,7%) Conclusion : Whole body staging in one step !!
- 47. 32 y-‐o, PE : Mass 4 cm, N+ Mammo : ?
- 48. 32 y-‐o, PE : Mass 4 cm, N+ Mammo : ? US : 31 mm, N+
- 49. 32 y-‐o, PE : Mass 4 cm, N+ Mammo : ? US : 31 mm, N+ MRI : 6 cm CCI, ER-‐, ErP-‐, Her2-‐ KI67 90% N+
- 51. Complete response Breast conservatory therapy
- 52. 61 y-‐o Nipple retracEon CCI : TN : KI67 > 95%
- 53. 61 y-‐o Nipple retracEon CCI : TN : KI67 > 95%
- 55. 61 y-‐o Nipple retracEon CCI : TN : KI67 > 95% Aqer 3 FEC 100
- 56. Take Home message § Tumor dimensions : MRI > US > Mammography MRI : First substracEon ü Over esEmaEon 15-‐70% ü Under esEmaEon 20-‐50% § Lymph node : US + Biopsy § Stagging : PET-‐CT / CT (thorax, abdomen, pelvis and bone) § Neoadjuvant chemotherapy follow up : MRI, PET-‐CT § MulEple Tumors : MRI assessment à Oncoplasty ?
- 57. cảm ơn bạn