Breast Cancer Diagnostic Imaging in

Dharmais Cancer Hospital

KardinahDept.Radiology Diagnostic Dharmais Cancer Hospital/National Cancer Center

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Breast Cervix Uteri Bronchus and Lung

Pharynx Colorectum Lymph Nodes

Leukemia Ovary Thyroid Gland

Hepar Oral Cavity Skin Soft Tissue

Top 13

Data Hospital Base 2005-2007RS.Kanker Dharmais

Imaging Modalities

Modalities

• Mammography

• Breast Ultrasound

• Breast MR

• Nuclear Medicine

• Guided Biopsy

Cancer Phase

• Screening

• Diagnosis – Primary Tumor

– Axillary Nodes

• Staging

• Restaging

• Response Evaluation

Level Diagnostic

Basic CBE

Limited Diagnostic Breast Ultrasound

Enhanced Diagnostic Mammography+SpecimenMammography

Maximal PET scan, MIBI scan,Breast MRIMammographic double reading

Guideline implementation for breast healthcare in low- and middle-income countries: diagnosis resource allocation.

Breast Health Global Initiative (BHGI)

DiagnosisPrimary tumor

• Mammography

• Breast Ultrasound

• Breast MR

• MIBI scan

Axillary nodes

• AxillaryUltrasound

• Sentinel node lympho-

scintigraphy

Histology

1 .Normal 2.Benign 5. Malignant3.Suspicious Benign4.Suspicious Malignant

Breast Imaging Reporting and Data System

Early Detection

• Clinical Breast Examination

• Pilot Project in 7 Districts

– Training general physicians and midwives

– Supervised by surgeon

–Referral system

Distribusi Diagnosis kelainanpayudara

3.8%

91.3%

1.0%

1.2%

2.6%

CBE+ Mammo

Absent

Normal

Benign

Malignant

Cyst

1139

Phase 1 Result , Research Funding from BHGI

Mobile Unit Mammography

Phase 1 Result , Research Funding from BHGI

Malignant Findings

Phase 1 Result , Research Funding from BHGI

Tumor size

Size (cm) CBE(N=2)

CBE +Mammography

(N=15)

Mean 4.3(3 - 5.6)

3.7(1.1 - 5.6)

Phase 1 Result , Research Funding from BHGI

Mammography

Breast Cyst

Axillary Nodes

Lymphnodes

Lymphnode

Sentinel Node

Ultrasound

parasternal

aksilaaksila

Conjunction Imaging

Mammography

• Dense Breast

• Asymmetric density

• Breast Lesion : Cyst or solid lesion, complicated cyst, complex cyst

Ultrasound

• Solid lesion with calcification

• Irregular border

• High risk patient

Early Detection Clinic

• > 35 yr

Mammography

• Normal

• Abnormal

Breast Ultrasound

• <35 yr

Breast Ultrasound

• Normal

• Abnormal

Mammography