Breast Cancer - Arab Medical Association Against Cancer

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Breast Imaging 62Breast diagnosisThe Breast Imaging Report and Data System (BIRADS) of the American College of Radiology (ACR)is today largely used in most of the countries where breast cancer screening is implemented. At thebeginning, BIRADS was only devoted to mammography but the fourth version of the Americanedition , published in 2003 is completed by ultrasonographic and MRI lexicon. BIRADS lexiconincludes a list of mammographic, ultrasonographic and MRI terms and an atlas containing illustrationsof each feature . In France the Societé Française de Radiologie translated the BIRADS lexicon inclassification “ACR” The aim of this classification is to standardize the terminology in each report, todeliver recommendations of the action to be taken, according to the probability of breast cancer risk. Itpermits also assessment of the findings and audit of screening programs.The first item concerns the composition of the breast : type 1 : fatty breast ( less than 10% of densetissue), type 2 : fibroglandular (10-49%dense tissue), type 3 heterogenous dense (49-90% of densetissue), type 4 dense and homogenous (more than 90 % dense tissue). Breast density is an independentrisk factor for breast cancer and also decreases mammographic sensitivity.Additional ultrasonography is often useful to complete the mammographic examination in type 3 or 4breasts. Then report describes each breast according to breast lexicon in mammography,ultrasonography or MRI when done, and the final conclusion is delivered according to the followingBIRADS categories , taking into account the worst classification.BIRADS 0 Incomplete , need for an additional imaging evaluationBIRADS 1 Normal. Normal interval follow upBIRADS 2 Typically benign. Normal interval follow upBIRADS 3 Probably benign. A short interval follow up isrecommended : 4 month follow up for masses and 6months follow up for microcalcificationsPPV for malignancy :less than 2%BIRADS 4 Suspicious abnormality : a biopsy should be considered PPV for malignancy :3-94%BIRADS 5 Highly suggestive of malignancy. Surgery should be PPV for malignancy :performed. Sometimes with prior Biopsy for neadjuvant more than 95 %therapy or when sentinel node imaging is included intreatmentBIRADS 6Histologically proven malignancy. Imaging is performedfor cancer staging or evaluation after neoadjuvant therapyHowever this classification doesn’t take into account extra-technical elements important in breastdiagnosis like the patient’s age, past or familial history, risk factors for breast cancer like BRCA 1 or 2mutations nor does it give elements of clinical examination. These elements can change themanagement of an image.MAMMOGRAPHY :TYPICAL BENIGN ASPECTS BIRADS 2Some masses and clusters of calcifications may be qualified of typically benign, and necessitate nosubsequent controlBENIGN MASSESNormal intramammary lymph nodes are usually small (less that one centimeter) and located in theupper outer quadrant of the breast , near a vessel. It is typical when it has a central or lateral lucencycorresponding to the hilar notch. In sonography it can be an oval mass, normal when large hilarhyperechogenicity and fine homogenous cortex are seen. In MRI it is often an oval mass withcircumscribed margin with hilar hyper T1 and T2, hypo T1 with fat saturation. But enhancement canbe early and intense. Masses with fatty components (FIG 7) can be identified as benin like Hamartoma(as breast in breast in mammography and in ultrasonography). It can also be oil cyst, lipoma or
Breast Imaging 63galatocele. Architectural distorsion can be also classed BIRADS2 when it is clearly related to priorsurgery and not modified on successive mammogramsIntramamary lymph nodeHamartomaFigure: Typical Benign Breast Mass with lipomatous changesFor diagnosis of a well cicumscribed mass, ultrasonography is necessary to distinguish between cystand tissular mass. Cysts may be round, oval or flat, well circumscribed with abrupt interface with thenormal breast tissue and often anechogenic with posterior enhancement. A typical cyst can beclassified BIRADS 2 (FIG 8). Atypical cyst because complex (association of anechogenic and solidparts) or complicated (not anechogenic) is classified as suspicious (BIRADS 4) and may necessitateaspiration with cytologic analysis.Figure:Transsonic massCircumscribed massFigure:Multiple Cysts, BIRADS 2
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1Chapter 1Epidemiology and risk ass
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Epidemiology and risk assessment 3c
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Epidemiology and risk assessment 55
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Epidemiology and risk assessment 7t
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Epidemiology and risk assessment 9O
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Epidemiology and risk assessment 12
Page 16 and 17: Breast Cancer screening 16Breast ca
Page 18 and 19: Breast Cancer screening 18situation
Page 20 and 21: Breast Cancer screening 20cause und
Page 22 and 23: Breast Cancer screening 22The rate
Page 24 and 25: Breast Cancer screening 24could be
Page 26: Breast Cancer screening 26These res
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Page 46 and 47: Breast Cancer and Genetic Predispos
Page 58 and 59: Breast Imaging 56Breast Cancer is t
Page 60 and 61: Breast Imaging 58Figure 5.2:Type I
Page 62 and 63: Breast Imaging 60Preoperative views
Page 66 and 67: Breast Imaging 64TYPICAL BENIGN CAL
Page 68 and 69: Breast Imaging 66Numerousfine linea
Page 70 and 71: Breast Imaging 68can appear under t
Page 72 and 73: Pathology and methods of analysiCha
Page 74 and 75: Pathology and methods of analysis 7
Page 96 and 97: Chapter 7CPlastic SurgerySurgery 13
Page 98 and 99: Surgery 135The safety of gel-filled
Page 100 and 101: Surgery 137Breast Reconstruction Us
Page 102 and 103: Surgery 139Goal Filled material Sha
Page 104 and 105: Chapter 8Radiotherapy of BreastRadi
Page 106 and 107: Radiotherapy 143When a patient pres
Page 108 and 109: Radiotherapy 145Chest wallThe targe
Page 110 and 111: Radiotherapy 147Various techniques
Page 112 and 113: Radiotherapy 149CT treatment planni
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Radiotherapy 151Implementation of p
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Systemic Adjuvant Therapy 153During
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Systemic Adjuvant Therapy 155therap
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Systemic Adjuvant Therapy 157In pra
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Systemic Adjuvant Therapy 159A. Ova
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Systemic Adjuvant Therapy 161and pl
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Chapter 12Management of advanced br
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Management of advanced breast cance
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Hormonal treatment 184Chapter 11Hor
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Hormonal treatment 186Endocrine Hor
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Hormonal treatment 188HORMONAL THER
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Hormonal treatment 190important for
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Hormonal treatment 192Conference (1
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Hormonal treatment 194trials have d
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Hormonal treatment 196combination o
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Hormonal treatment 198Metastatic br
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Prognostic factors 200The predictio
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Prognostic factors 202the term of R
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Prognostic factors 2043. Histologic
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Prognostic factors 2066 Other histo
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Prognostic factors 2087. c-erbB-2c-
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Prognostic factors 210biology has l
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Prognostic factors 212changes produ
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Prognostic factors 214Her2 patients
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CriteriaP valueN+ 10 -5SBR grade 10
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Prognostic factors 218Table 14.7. R
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Prognostic factors 220• Metalloth
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Persistent Pain 223Although breast
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Persistent Pain 225• Pain associa
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Persistent Pain 227• Heavy painfu
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Persistent Pain 2292. Analgesics ar
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Persistent Pain 231for long duratio
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Persistent Pain 233Implantable Syst
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Breast Cancer - Arab Medical Association Against Cancer

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