Breast Cancer - Arab Medical Association Against Cancer

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Breast Imaging 68can appear under treatment secondary to necrosis. The question of surgeons is to identify patients whocould have a breast-conserving surgery. MRI is a better exam for the estimation of residual diseasethan mammography or ultrasonography. But sensitivity for evaluating residual tumor must still bestudied because it seems to be perfectible. In some small series , patients without residualenhancement on MRI still had residual lesions on pathologic analysis . On the other hand, MRI isgood for detection of non-responder or progression. In broad outline, at the end of the treatment, MRIcan depict three types of response: Tumoral stability or progression, Concentric shrinking of the tumorleading to disappearance of the visible tumor, fragmentation of the tumor that is contre-indication forconservative surgery. For predicting early response after initiation of the treatment, MRI, FDG-PETImaging and MRI Spectroscopy seem to be promising.Tumor recurrence after lumpectomyTumor recurrence after lumpectomy occurs at the rate of 10- 15 % in 20 years, almost 2% per yearduring the five first years. Follow up consists in a first mammography 6 months after the end oftherapy and then annually. Ultrasonography is useful to precise mammographic abnormalities. Thecomparison of successive mammographies is a precious aid. Normal Aspect: During the firstmammographic controls skin thickening and architectural distortion due to surgical scar can beobserved. Ultrasonography may be useful to eliminate mass syndrome but doubtful images can becreated by post-therapeutic fibrous tissue.Fat necrosis can appear after treatment and the early formcan be confusing. Typically it presents like a densification or architectural distorsion associated with afine limited lipomatous image. Calcification can appear in the periphery, typical when clear at thecenter macrocalcifications, sometimes ambiguous at the early stage and needing an earlier control.Abnormal aspect: A mass or microcalcifications emergence are usual aspects but can also only be scarmodification or densification increase. In these cases, MRI can be very helpful: Indeed in the treatedbreast, MRI is more specific than in the non treated breast because with radiotherapy, normal ordystrophic breast tissue often does not enhance anymore. So the VPN and the specificity of MRI isvery high and allows not to biopsy treated breast if there is no enhancement. When enhancement isobserved, biopsy will be performed according to the best radiologic translation.Breast cancer ScreeningMass screening for early detection of breast cancer is available in many countries . In the generalpopulation, the risk of breast cancer is 0.6 % per ten-years period before 40 years and 2.8% for thefifth ten years period, so one woman per 8 can be concerned. The aim of early detection is to treatearlier and to decrease mortality. The international quality criterions of a screening campaign are aparticipation rate up to 70%, a reconvocation rate inferior to 7%, a PPPV of biopsy superior to 50%and a rate of interval cancer inferior to 2%. In the general population, screening procedure rests onhigh quality mammograms and permanent quality control of the complete chain of mammographyfrom the tecnical acquisition to the radiologist. Clinical examination improves detection. Sensitivity ofmammography is better in breast type 1 or 2 than in type 3 or 4 (respectively 98, 85, 83, and 68%).The use of CAD does not improve detection rate and can’t take the place of second reading. Theassociation of ultrasonography in dense breasts clearly improves sensitivity of mammography. Thereis no indication of MRI in screening of the general population because MRI is less performant thanmammography for microcalcifications and it is sensitive but not very specific and the rate of recallmay be to important.On the other hand, it is now demonstrated that screening in the population of women with a high riskof cancer and with genetic mutations like BRCA1 or 2, rests on association of annual mammogram,ultrasonography and MRI, because these young women, who often have dense breasts, also may haveround cancer, high grade cancer or interval cancer (FIG 17). The sensitivity of mammography alone islower and needs the adjonction of ultrasonography if possible targeted after MRI.
Breast Imaging 69Woman, Mutation BRCA1 CarrierMammographic and sonographic BIRADS 3 IMAGEBiopsy : Invasive CarcinomaFigure:ConclusionDuring the past ten years, technical improvements have been essential for breast imaging : Evaluationof digital mammography proved to be competent for breast cancer screening, improvement ofsonographic intallations, extension and evaluation of Breast MRI, diversification of percutaneousbiopsy with all modalities of guidance, new technical developments like tomosynthesis, MRIspectroscopy. If primary senologic evaluation always lies on clinical exam, mammography andultrasonography, it’s now relatively clear that MRI can be essential in care of breast cancer forpreoperative staging, evaluation of neoajuvant therapy response, supervision of treated breasts, butalso for screening of women with high risk for breast cancer like genetic mutations BRCA1 and 2carriers
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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
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Breast Cancer screening 16Breast ca
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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 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 64 and 65: Breast Imaging 62Breast diagnosisTh
Page 66 and 67: Breast Imaging 64TYPICAL BENIGN CAL
Page 68 and 69: Breast Imaging 66Numerousfine linea
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
Page 114 and 115: Radiotherapy 151Implementation of p
Page 116 and 117: Systemic Adjuvant Therapy 153During
Page 118 and 119: 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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