How will you approach the 35 year old, with a 2 x 2 x 2cm, firm, mobile, well circumscribed non...
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Transcript of How will you approach the 35 year old, with a 2 x 2 x 2cm, firm, mobile, well circumscribed non...
How will you approach the 35 year old, with a 2 x 2 x
2cm, firm, mobile, well circumscribed non tender mass on the right breast?
Role of imaging modality
• Mammography– plays a central part in early detection of breast cancers
because it can show changes in the breast up to two years before a patient or physician can feel them.
– Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available.
• Digital and conventional mammography – both use x-rays to produce an image of the breast
• Conventional mammography: image is stored directly on film• Digital mammography: images stored as a computer file
• full-field digital mammography (FFDM); mammography system in which the x-ray film is replaced by solid-state detectors that convert x-rays into electrical signals used to produce images
• can be enhanced, magnified, or manipulated for further evaluation more easily
• Digital mammography advantages over conventional mammography:– Health care providers can share image files electronically, making
long-distance consultations between radiologists and breast surgeons easier.
– Subtle differences between normal and abnormal tissues may be more easily noted.
– Fewer follow-up procedures may be needed. – Fewer repeat images may be needed, reducing the exposure to
radiation.
http://www.radiologyinfo.org/en/info.cfm?pg=mammo
• Ultrasound– to differentiate solid from cystic masses; looks for shape and
texture– to provide guidance for interventional breast procedures such
as cyst aspiration or core biopsy– useful when a palpable mass is partially or poorly seen on a
mammogram, especially in young women– When added to mammography= improved breast cancer
detection in high-risk women (Journal of the American Medical Association, 2008)
A mammogram was taken as seen in the picture. Is this benign or
malignant?
Dx:BENIGN
CYST
Differentiate radiologically a benign lesion from a malignant one.
BENIGN MALIGNANT
Smooth contour Grow significantly
Well-circumscribed Stellate or star-bust shaped that extends in all directions
Encapsulated Calcifications
With “halo sign”
Will not change much in shape or size
Difference in ultrasound findings.BENIGN MALIGNANT
intense uniform hyperechogenicity Irregular/spiculated borders (“Silhouette sign”)
ellipsoid or wider-than-tall (parallel) orientation along with a thin, echogenic capsule
taller-than-wide orientation
2 or 3 gentle lobulations and a thin, echogenic capsule
angular margins
marked hypoechogenicity
posterior acoustic shadowing
punctuate calcifications
duct extension
branch pattern
microlobulation.
Should the patient have a mother who is a breast cancer survivor, how would
that information change your management?
Breast Cancer Screening Tests
• Mammogram – is the best tool available for early breast cancer detection – can often identify cancer before symptoms appear and can
reveal calcium deposits in the breast, which may be an early sign of cancer
– HIGH RISK: annual mammogram beginning at an age that is 5 to 10 years younger than the youngest member of the family with breast cancer
Breast Cancer Screening Tests• Clinical breast exam – thorough physical examination of the breasts done by
a physician or nurse practitioner – HIGH RISK: recommended every 6 to 12 months
• Self breast exam – identify breast abnormalities and should be
performed monthly, about one week after the end of your period
• Breast MRI – For extremely dense breast tissue that make
mammograms difficult to interpret
Self breast Exam
National Cancer Institute