Breast Cancer: Diagnostic Imaging and Therapeutic Guidance

Description

Breast Cancer: Diagnostic Imaging and Therapeutic Guidance provides a concise, practical, and practice-based source of up-to-date diagnostic and therapeutic information for the general radiologist. In the diagnostic phase of evaluating breast disorders, the overriding consideration in the examination and assessment is to reduce false diagnoses to the absolute minimum-a principle wholly in the interests of the patient. The particular diagnostic pathway chosen will depend on the highly variable individual presentations and the associated findings. A major focus of the book is the comparative value of the various diagnostic imaging modalities. As well as discussing conventional mammography and adjunct modalities such as breast ultrasound and galactography, the text also showcases the superior utility of contrast-enhanced magnetic resonance imaging in providing the highest rate of detection of cancers at any stage. As well as radiological diagnosis, sections written by top specialists cover the interventional procedures for obtaining biopsies and also the surgical and medical therapy of breast carcinoma. Key Features: Combined authors' experience of more than 100 years provides this work with great depth and expertise.Richly illustrated with almost 600 images, including full color histology, patient photographs, and hundreds of radiological studies.BI-RADS classification for mammography, breast ultrasound, and breast MRI.Adjunct topics covered include screening and staging; lymph nodes; breast reconstruction; chemotherapy, also with respect to endocrine-active tumors; radiation therapy; tumors of the male breast; logistics in the breast care center; and psychosocial care. Breast Cancer: Diagnostic Imaging and Therapeutic Guidance is certain to prove an invaluable tool for all general radiologists involved in the evaluation and treatment of patients with breast cancer. Breast Cancer: Diagnostic Imaging and Therapeutic Guidance Title Page Copyright Contents Preface Contributors Abbreviations Part 1: Anatomy, Physiology, and Pathology of the Breast 1 Development, Anatomy, and Physiology of the Mammary Gland 1.1 Development 1.2 Anatomy 1.3 Physiology Bibliography 2 Tumor Formation 2.1 Mutation, Carcinogenesis, and Angiogenesis 2.2 Risk Factors 2.3 Genetic Risk Factors 2.4 Prevention 2.4.1 Primary Prevention 2.4.2 Secondary Prevention 2.4.3 Tertiary Prevention 2.5 Epidemiology, Incidence, and Mortality Bibliography 3 Pathology of Benign and Malignant Changes in the Breast 3.1 Benign Changes 3.1.1 Histological Principles 3.1.2 Nonneoplastic, Nonproliferative Diseases of the Breast 3.1.3 Benign Tumor-Forming Diseases 3.2 Malignant Changes in the Breast 3.2.1 Classification of Malignant Breast Tumors (WHO Classification, B-Categories) 3.2.2 Prognostic and Predictive Factors 3.2.3 Papillary Lesions 3.2.4 Ductal Carcinoma In Situ 3.2.5 Microinvasive and Invasive Breast Carcinoma 3.2.6 Tumors of the Nipple 3.2.7 Malignant Mesenchymal Tumors and Lymphomas of the Breast 3.2.8 Metastatic Tumors 3.3 Acknowledgments Bibliography Part 2: Breast Diagnostics 4 Nonimaging Diagnostics 4.1 History 4.2 Informed Consent 4.3 Self-Examination 4.4 Inspection 4.5 Palpation Bibliography 5 Mammography 5.1 Technique and Methods 5.1.1 Principles of X-ray Mammography 5.1.2 Components of a Mammography System 5.1.3 Exposure Parameters 5.1.4 Image Quality 5.1.5 Analog Mammography 5.1.6 Digital Mammography 5.1.7 Radiation Exposure 5.2 Parameters and Positioning 5.2.1 Standard Projections 5.2.2 Supplementary Views 5.2.3 Galactography 5.2.4 Mammography of the Male Breast 5.2.5 Quality Assurance in Parameters and Positioning 5.3 Interpretation of Mammograms 5.3.1 Terminology 5.3.2 Tissue Density in a Mammogram According to the ACR BI-RADS Atlas 5.3.3 Interpretation Criteria 5.3.4 BI-RADS Classification of Mammography 5.3.5 Normal Findings in the Mammogram Bibliography 6 Breast Ultrasonography 6.1 Technique and Methods 6.1.1 Basic Principles 6.1.2 Device Adjustments 6.1.3 Examination Technique 6.1.4 Ultrasound Techniques 6.1.5 Quality Assurance 6.2 Evaluation 6.2.1 Terminology 6.2.2 Tissue Type in Sonography 6.2.3 Evaluation Criteria 6.2.4 BI-RADS Classification of Breast Ultrasonography 6.2.5 Normal Findings in Sonography Bibliography 7 Magnetic Resonance Imaging of the Breast 7.1 Technique and Methods 7.1.1 Basic Principles 7.1.2 Tumor Detection 7.1.3 Equipment 7.1.4 Timing of the Examination 7.1.5 Patient Positioning 7.1.6 Measurement Parameters 7.1.7 Image Postprocessing 7.1.8 Implant Evaluation 7.1.9 Nonestablished Examination Techniques 7.2 Evaluation 7.2.1 Terminology 7.2.2 Perfusion Pattern 7.2.3 Findings in the T1-Weighted Precontrast Image 7.2.4 Findings in the T2-Weighted Image 7.2.5 Findings in the T1-Weighted Contrast-Enhanced Image 7.2.6 Evaluation Criteria 7.2.7 BI-RADS Classification of MRI of the Breast 7.2.8 Normal Findings in MRI of the Breast Bibliography 8 Imaging of Breast Lesions 8.1 Benign Findings 8.1.1 Cysts 8.1.2 Inflamed Cysts 8.1.3 Complex Cysts 8.1.4 Myxoid Fibroadenoma 8.1.5 Fibrotic Fibroadenoma 8.1.6 Adenoma 8.1.7 Hamartoma 8.1.8 Lipoma 8.1.9 Mammary Fibrosis 8.1.10 Adenosis of the Breast 8.1.11 Fibrocystic Condition of the Breast 8.1.12 Adenomyoepithelioma 8.1.13 Acute Nonpuerperal Mastitis 8.1.14 Chronic Nonpuerperal Mastitis 8.1.15 Intramammary Lymph Nodes 8.1.16 Pseudoangiomatous Stromal Hyperplasia 8.1.17 Seroma 8.1.18 Hematoma 8.1.19 Fat Necrosis (Oil Cyst) 8.1.20 Abscess 8.1.21 Postoperative Scars 8.2 Findings with Ambiguous Biological Potential 8.2.1 Papillomas 8.2.2 Radial Scars 8.2.3 Atypical Ductal Hyperplasia 8.2.4 Phyllodes Tumors 8.2.5 Cysts with Intracystic Proliferation 8.2.6 Lobular Intraepithelial Neoplasia 8.3 Intraductal Carcinoma 8.3.1 Ductal Carcinoma In Situ (Low Grade) 8.3.2 Ductal Carcinoma In Situ (Intermediate Type) 8.3.3 Ductal Carcinoma In Situ (High Grade) 8.4 Invasive Tumors 8.4.1 Invasive Ductal Carcinoma 8.4.2 Invasive Lobular Carcinoma 8.4.3 Tubular Carcinoma 8.4.4 Medullary Carcinoma 8.4.5 Mucinous Carcinoma 8.4.6 Invasive Papillary Carcinoma 8.4.7 Sarcomas 8.4.8 Triple-Negative Carcinoma 8.4.9 Paget’s Disease of the Nipple 8.4.10 Inflammatory Carcinoma 8.4.11 Systemic Diseases Involving the Breast 9 Breast Intervention 9.1 Biopsy 9.1.1 Objective of Percutaneous Tissue Sampling 9.1.2 Percutaneous Tissue Sampling Equipment and Implementation 9.1.3 Interventional Imaging 9.1.4 Classification of Findings 9.1.5 Tumor Seeding and Mechanical Tumor Induction 9.1.6 Quality Assurance 9.2 Localization 9.2.1 Objective of Pretherapeutic Localization 9.2.2 Equipment and Implementation 9.2.3 Quality Assurance Bibliography Part 3: Prevention and Therapy of Breast Cancer 10 Examination Concepts 10.1 Prevention 10.2 Early Breast Cancer Detection (Secondary Prevention) 10.2.1 Mammography Screening 10.2.2 Individualized Examination Concepts 10.2.3 Early Detection inWomen with a High-Risk Profile 10.2.4 Future Concepts of Early Breast Cancer Detection 10.3 Diagnostic Work-up 10.4 Pretherapeutic Local Staging 10.5 Pretherapeutic Peripheral Staging 10.6 Follow-up Care 10.7 Implant Evaluation 10.8 Evaluation of the Male Breast Bibliography 11 Surgical Treatment of Breast Carcinoma 11.1 Significance of Surgery in the Context of Multimodal Treatment of Breast Carcinoma 11.2 Types of Breast Carcinoma 11.2.1 Lesions of Uncertain Biological Potential (B3 Lesions) 11.2.2 Preinvasive Carcinoma (Ductal Carcinoma in Situ; B5a) 11.2.3 Invasive Carcinoma (B5b) 11.3 Surgical Treatment of the Primary Lesion 11.3.1 Oncologic Aspects 11.3.2 Technical Aspects 11.4 Lymph Node Surgery 11.4.1 Procedure for Clinically Negative Node Status 11.4.2 Procedure for Clinically Positive Nodal Status 11.4.3 Procedure for Clinically Negative Node Status and Positive Sentinel Node 11.5 Secondary Breast Reconstruction 11.5.1 Timing the Reconstruction: Primary vs. Secondary Reconstruction 11.5.2 Alloplastic Reconstruction (Implant Reconstruction) 11.5.3 Autologous Reconstruction (Reconstruction Using Endogenous Tissue) 11.5.4 Nipple Reconstruction Bibliography 12 Medical Treatment of Breast Cancer 12.1 Basic Principles and Objectives 12.2 Adjuvant Drug Therapy 12.2.1 Adjuvant Chemotherapy 12.2.2 Neoadjuvant Therapy 12.2.3 Adjuvant Endocrine Therapy 12.2.4 Antibody Therapy 12.3 Medical Treatment in Locoregional Recurrence 12.4 Medical Treatment of Distant Metastases 12.4.1 Endocrine Therapy in Premenopausal Patients with Distant Metastases 12.4.2 Endocrine Therapy in Postmenopausal Patients with Distant Metastases 12.5 Endocrine Maintenance Therapy after Completing Chemotherapy 12.6 Chemotherapy of Metastatic Breast Cancer Combined with New Agents Bibliography 13 Radiotherapy of Breast Cancer 13.1 Adjuvant Radiotherapy after Breast-Conserving Surgery 13.2 Adjuvant Radiotherapy after Mastectomy 13.3 Effectiveness of Adjuvant Radiation Therapy: Prognostic Factors 13.4 Integration of Adjuvant Radiotherapy into the Multimodal Treatment Concept 13.5 Target Volume and Dose Concept 13.5.1 Clinical Target Volume: Former Tumor Region, Mammary Gland, Chest Wall, and Regional Lymph Channels 13.5.2 Partial Breast Irradiation 13.5.3 Shortened Treatment Time: Alternative Fractionation Schemes 13.6 Acute Side Effects and Complications of Adjuvant Radiation Therapy 13.6.1 Acute Side Effects 13.6.2 Late Complications of Radiation Therapy 13.7 Planning and Implementing Radiation Therapy 13.8 Radiotherapy in Primarily Inoperable Tumors, Recurrences, and Metastatic Disease 13.9 Summary Bibliography 14 Management of a Diagnostic Breast Center 14.1 Expertise 14.2 Equipment 14.3 Facility Design 14.3.1 Doctor’s Consultation Room 14.3.2 Mammography and Sonography Rooms 14.3.3 Breast MRI Room 14.3.4 Rooms for a Second Ultrasound Unit and for Interventional Procedures 14.3.5 Recovery Room 14.4 Ambiance 14.5 Communication 15 Logistics in an Interdisciplinary Breast Center 15.1 Background 15.2 Structure of a Certified Breast Center 15.3 Treatment Pathways in a Breast Center 15.4 Outlook Bibliography 16 Counseling Techniques and Psychosocial Support 16.1 Compliance 16.1.1 Quality of the Medical Services 16.1.2 General and Personal Requirements 16.1.3 Structural, Organizational, and Procedural Components 16.1.4 Interactive and Communicative Competence 16.2 Communication 16.2.1 General Principles of Communication 16.2.2 Communication: Dealing with the Patient 16.2.3 Communicating Results to the Patient 16.3 The Patient’s Flow through the Department 16.3.1 Station 1: Registration 16.3.2 Station 2: History and Physical Examination 16.3.3 Station 3: The Diagnostic Procedure 16.3.4 Station 4: Communication of Results and Concluding Consultation 16.4 Summary Bibliography Index