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Product Description. Features of Breast Imaging : Examples of critical can't-miss cases that must be accurately diagnosed to avert potential disaster in daily practice and on exams Clearly labeled, high-quality mammograms, ultrasounds and MRIs help you absorb key findings at-a-glance A scratch-off code in each book that provides a year of free access to a searchable online database of must-know cases, the cases in the book, plus an additional cases only found online Category: Radiology.
Features of Breast Imaging : Examples of critical can't-miss cases that must be accurately diagnosed to avert potential disaster in daily practice and on exams Clearly labeled, high-quality mammograms, ultrasounds and MRIs help you absorb key findings at-a-glance A scratch-off code in each book that provides a year of free access to a searchable online database of must-know cases, the cases in the book, plus an additional cases only found online Category: Radiology , Breast Imaging , Resident , Resident, Radiology. Rate this product. In Europe, breast ultrasound was rapidly embraced by both breast surgeons and radiologists and used, on a routine basis, for breast cancer screening and for diagnostic purposes since the s.
In the United States, it took much more time for breast ultrasound to be accepted as a breast imaging method on its own account, especially if combined with advanced technical approaches such as color Doppler, 3-dimensional 3D ultrasound, and shear-wave elastography Fig. With the addition of a specific chapter on breast ultrasound acquisition guidelines, terminology, and image interpretation criteria in the Breast Imaging Reporting and Data System lexicon in , the use of ultrasound in the United States is now growing. Breast MRI was developed in the late s.
Whereas European vendors offered breast surface coils that covered both breasts, US vendors offered single-breast coils only. Kaiser and Zeitler 13 were the first to describe that breast cancers not only enhance but exhibit fast enhancement, such that fast imaging is useful not only for detection but also for differential diagnosis.
Radiology Case Review Series: Breast Imaging: Medicine & Health Science Books @ giuliettasprint.konfer.eu An Introduction to Microwave Imaging for Breast Cancer Detection Martin O 'Halloran . Radiology Case Review Series: Breast Imaging. By Chris Flowers.
At that time, this meant to compromise on spatial resolution. With the coarse spatial resolution resulting from a reduced —acquisition matrix over a bilateral field of view FOV , a subtle analysis of morphological details of enhancing tissues was impossible, which closed the loop for the perceived importance of fast, dynamic imaging for differential diagnosis. In the United States, the acquisition matrix could be spent on a much smaller FOV of the single-breast setting. This allowed imaging with higher spatial resolution, thus increasing the perceived importance of morphology over kinetics.
Body radiologists were keen to apply active fat suppression for contrast-enhanced T1-weighted imaging. The different technical approaches did also affect how breast MRI was used clinically, for example, first reports on the use of MRI for preoperative staging of the affected single breast came from the United States, 20 whereas the first report on the use of MRI for screening which implies imaging both breasts stems from our group.
After its advent in the s, there was not much technical development in the field of x-ray mammography for decades to follow. Until the early s, the only issue I remember is that radiologists discussed on whether the medio-lateral-oblique projection should replace the mediolateral view. The first major advancement in the field of radiographic breast imaging was made when digital mammography was introduced in the early s. Within less than a decade, it became the standard of care.
This was not so much for reasons of improved diagnostic yield, accuracy, or cancer detection rate compared with film-screen mammography ; the DMIST trial, published in , on the comparison of film screen with digital mammography in more than 50, women, yielded surprisingly similar detection rates for digital versus film-screen mammography. In , the first results on calculating tomograms from digital mammography units were published. Yet, DBT does indeed help compensate for some of the weaknesses of regular projection mammography because the resulting tomographic images help separate some of the superpositioned normal and diseased tissues and thus improve the detection of cancers.
First introduced in — as an add-on imaging method to complement digital mammography , for example, for problem solving, 24 Digital breast tomosynthesis was quickly also absorbed for screening purposes.
Several large-scale clinical trials on more than several hundreds of thousands of screening examinations were conducted, written, and published within only a couple of years. In short, it helps increase both the sensitivity and specificity of mammographic breast cancer detection. The use of DBT for screening had been criticized because of the additional dose of ionizing radiation it requires when used in addition to digital mammography. In this approach, the DBT data set is used to calculate a 2D projection image, that is, a synthetic regular mammogram.
These synthetic 2D mammograms were shown to be as useful for breast cancer diagnosis as are regular digital mammograms. Accordingly, today, DBT plus synthetic 2D- mammography has become the new standard in radiographic breast imaging for diagnosis of breast cancer Fig. Clearly, use of contrast enhancement will increase the cancer yield of 2D mammography.
Moreover, contrast-enhanced spectral mammography or DBT is associated with ionizing radiation and uses a contrast agent that has a significantly worse safety profile than that of MR-based contrast agents. The bottom line is that for radiographic breast imaging, the development direction is toward increasingly complex, increasingly demanding and increasingly expensive acquisition methods. This is achieved by stripping traditional lengthy pulse sequence protocols down to their very essence, thus reducing patients' magnet time as well as radiologist's image reviewing time.
The long-term goal is to increase access to MRI, for example, breast MRI , by reducing costs associated with such examinations see Screening for breast cancer : why less can be more, but more is still more. Therefore, there is evidence to suggest that breast MRI will diversify. There will be abbreviated breast MRI protocols, possibly combined with future dedicated MR systems that are optimized for high-throughput imaging of dedicated body regions, for population-scale cancer screening.
Additionally, there will be advanced multiparametric, possibly hybrid breast MRI , probably on advanced high-field systems, that will be used for disease classification in patients with suspected or already proven to have breast cancer. The latter will be important for reasons described subsequently:.
Until approximately 10 years ago, breast cancer was classified mainly based on its morphology ductal, lobular, tubular, and the like , and further treatment assignment was based mainly on TNM stage ie, cancer size, presence or absence of lymph node metastases, and presence or absence of distant metastases. With the advent of molecular subtyping of breast cancer , this concept has been more or less abandoned, or at least has been greatly amended. Classification of breast cancers and treatment stratification is now based on their different gene expression profile.
In clinical practice, breast cancers are currently grouped into 4 major classes that are distinguished based on different patterns of genomic additions and deletions. These groups are: luminal-A, luminal-B with or without human epidermal growth factor receptor 2 [HER2] overexpression , HER2-positive, and triple-negative nonbasal and basal. In the clinical patient, these different subtypes are determined by surrogate markers, that is, by immunohistochemical findings, to obviate the need for gene expression profiling in every patient.
These surrogate markers are a presence of estrogen and progesterone receptors ER, PR , b overexpression of the oncogene HER-2, and c proliferation rate as measured by Ki Genomic subtypes provide prognostic information. On the other end of the spectrum, triple-negative basal-like are a heterogeneous group of biologically aggressive breast cancers that may behave clinically almost like small-cell lung cancers and may take unpredictable metastatic pathways.
Genomic subtypes drive the choice of systemic treatment. Luminal-A breast cancers respond so well to antihormonal treatment tamoxifen or aromatase inhibitors that, usually, no cytotoxic chemotherapy is recommended even if axillary lymph nodes are positive. In contrast, cytotoxic chemotherapy is consistently recommended for the remaining subtypes.
Triple-negative tumors TNT receive systemic chemotherapy alone, possibly including new agents such as poly ADP ribose polymerase inhibitors or androgen receptor inhibitors. Since tumor biology molecular subtyping has replaced previous criteria for prognostic evaluation as well as previous concepts for treatment allocation, there is a growing interest in establishing innovative breast imaging methods, in particular, contemporary magnetic resonance—based in vivo imaging biomarkers, to help classify tumor biology. Such techniques are diffusion-weighted imaging DWI and its derivatives like diffusion kurtosis imaging and intravoxel incoherent motion imaging, DCE-MRI and its kinetic analyses, and 1H or 31P MR spectroscopy, all of which can be combined into so-called multiparametric mp breast MRI protocols.
For instance, specifically high-grade tumors or tumors with high Ki proliferation fraction are usually hypercellular compared with surrounding normal breast tissue, which translates into restricted diffusion of free water molecules on DWI.
Mori et al 50 have indeed shown that ADC values correlate with proliferation rates in luminal-B cancers. The increased cellular ie, membrane turnover in rapidly growing tumors will lead to a detectable choline peak in proton MR spectroscopy. This is achieved by releasing peptides like vascular endothelial growth factor that induce local angiogenesis. Angiogenesis leads to a fundamental change of a tumor's microvascular architecture, with sprouting of existing vessels as well as development of de novo formed vessels, usually with fenestrated vessel wall linings that go along with increased vessel permeability.
The increased metabolic turnover leads to an increased amount of toxic waste products that are removed through dilated drainage veins. The increased perfusion leads to the well-known strong and early enhancement in DCE-MRI, and the increased permeability, together with the efficient venous drainage, cause the washout time course that is characteristic of breast cancer.
The increased permeability leads to leakage of larger molecules such as proteins from the intravascular to the interstitial space, which will increase the oncotic colloid-osmotic pressure within the cancer, a fact that drags water from the intravascular into the interstitial space and thus increases the interstitial water volume fraction. This, in turn, will correlate with a cancer's signal in T2-weighted imaging.
Visualization of such functional information is useful in clinical practice for a number of purposes. First, it can be exploited for further differential diagnosis of enhancing lesions seen in breast MRI , that is, for the further differentiation of benign, high-risk, and malignant lesions in breast MRI. The combination of high-resolution cross-sectional morphology, enhancement kinetics, a lesion's signal in T2-weighted images and in DWIs leads to a high specificity and positive predictive value of contemporary breast MRI protocols.
The diagnostic accuracy achieved with such protocol is sufficient to be used for so-called problem solving. Accordingly, and in contrast to currently held beliefs, we have recently shown that breast MRI can indeed be used to definitely settle screen-detected mammographic or ultrasound findings and thus help avoid unnecessary biopsy.
Second, such functional imaging methods promise to provide additional independent diagnostic information that adds to our understanding of a cancer's ability to grow and metastasize.
Author Kakoli Ghosh Dastidar. Smith, Usha D. The book aims to provide the specialist with a detailed Breast Imaging: Case review series. Mettler, Jr.
The current focus on tumor genomics ignores the fact that successful tumor growth does not only depend on a tumor's genomic toolbox but also on its microenvironment, that is, features of the tissue that hosts the cancer. The interaction between a cancer and its microenvironment, and the degree to which a cancer is successfully shaping its environment to sustain its growth, are probably best assessed by noninvasive in vivo functional imaging. Accordingly, we propose that in the future, such mp MRI techniques will be used to help amend the assessment of a tumor's aggressiveness and its biologic and prognostic importance.
Third, an established clinical situation where mp breast MRI is used is to monitor response to systemic treatment.