SYB 1Erin Gundersen MS IV

Breast Cancer 

Main Types

In Situ- tumor cells confined to ducts and lobules with no invasion Ductal

• Calcifications• Palpable mass

Lobular• Not palpable, no mammographic appearance• Incidental finding• Increase risk of invasive cancer

Main Types

Invasive Carcinoma- invade breast stroma, can spread or metastasize

Infiltrating ductal — 76 percent Invasive lobular — 8 percent Ductal/lobular — 7 percent Mucinous (colloid) — 2.4 percent Tubular — 1.5 percent Medullary — 1.2 percent Papillary — 1 percent

Mammography Spiculated soft tissue mass

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 DCIS Mucin-secreting tumors Benign- vascular, skin, rim-like, coarse, smooth

round or oval

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 U/S guided biopsy

Limitations Not see microcalcification 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 2008. 6 Oct. 2008 <http://www.uptodateonline.com/online/content/topic.do?topickey=breastcn/13029&selectedtitle=1~5&source=search_result#1>.

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): 427-37.

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): 478-90.