Breast & Gynecological Diseases Role of Imaging in the Management

Description

This book is primarily a symptom-based guide to Breast and Gynecologic Imaging. Most clinical publications focus on a specific pathology such as "Imaging and/or management of ovarian cancer," but in clinical practice, patients do not present with a diagnosis. Physicians are presented with clinical symptoms, and appropriate use of imaging after a clinical assessment is critical from the point of view of effective intervention to treat a patient. CMS now mandates a clinical decision support system to justify imaging. This is based on making use of appropriate modalities for specific clinical problems that are deemed so by professional society guidelines. In an era of emphasis on cost effective, high quality health care delivery, it is critical for clinicians in training and practice to have a resource that outlines scientifically sound and professional society endorsed criteria for appropriate work up of patients’ symptoms. This book applies this symptom-based approach to women’s health. Authors are focused on providing a scientifically proven resource to gynecologists, obstetricians, radiologists and internists involved in the management of common symptoms affecting women. Each chapter is based on a common breast or gynecological problem and how patients are triaged for imaging. The implications of the findings and the most appropriate management of the patient are also presented. The text focuses on providing the most effective methods currently available to investigate commonly encountered symptoms in women’s health. In addition, there are chapters that outline rationale of screening for breast cancer in women with an average risk and those with an elevated risk for breast cancer as well as a clinician guide to understanding multidisciplinary approach to the Breast cancer patient. This is an ideal guide for gynecologists, obstetricians, radiologists, and internists working in women’s health. Editorial Reviews From the Back Cover This book is primarily a symptom-based guide to Breast and Gynecologic Imaging. Most clinical publications focus on a specific pathology such as "Imaging and/or management of ovarian cancer," but in clinical practice, patients do not present with a diagnosis. Physicians are presented with clinical symptoms, and appropriate use of imaging after a clinical assessment is critical from the point of view of effective intervention to treat a patient. CMS now mandates a clinical decision support system to justify imaging. This is based on making use of appropriate modalities for specific clinical problems that are deemed so by professional society guidelines. In an era of emphasis on cost effective, high quality health care delivery, it is critical for clinicians in training and practice to have a resource that outlines scientifically sound and professional society endorsed criteria for appropriate work up of patients’ symptoms. This book applies this symptom-based approach to women’s health. Authors are focused on providing a scientifically proven resource to gynecologists, obstetricians, radiologists and internists involved in the management of common symptoms affecting women. Each chapter is based on a common breast or gynecological problem and how patients are triaged for imaging. The implications of the findings and the most appropriate management of the patient are also presented. The text focuses on providing the most effective methods currently available to investigate commonly encountered symptoms in women’s health. In addition, there are chapters that outline rationale of screening for breast cancer in women with an average risk and those with an elevated risk for breast cancer as well as a clinician guide to understanding multidisciplinary approach to the Breast cancer patient. This is an ideal guide for gynecologists, obstetricians, radiologists, and internists working in women’s health. About the Author Mahesh Shetty, MD, FRCR, FACR, FAIUM is a Clinical Professor of Radiology at Baylor College of Medicine. He has been practicing in the Texas Medical Center since 1995 after completion of a Fellowship in MRI and Abdominal Imaging at the University of Chicago and a Fellowship in Body Imaging at Baylor College of Medicine. He also holds the distinction of being granted fellowship in the American College of Radiology, Society of Breast Imaging and the American Institute of Ultrasound in Medicine. Dr Shetty is currently in private practice and is the Managing Director of The Breast and Imaging Center, a Women’s Imaging Network for the Texas Gulf coast division of the Privia Medical Group. Dr. Shetty’s clinical expertise is in Breast and Gynecological Imaging. He is extensively published in his area of expertise and has authored two textbooks, four special issue journals, book chapters and clinical publications. He has served as the Director of Mammography at Ben-Taub General Hospital and more recently at the Woman’s Hospital of Texas, and is past president of the Houston Radiological Society and an examiner in Mammography for the American Board of Radiology. He is a recognized International Visiting Professor of the Radiological Society of North America and has lectured extensively in Asia, Europe, Africa and Latin America. Foreword Foreword Preface Contents Contributors 1: Imaging the Symptomatic Breast in the Pediatric, Young, Pregnant, Lactating, and Transgender Patient Imaging of the Breast During Pregnancy and Lactation Imaging of the Breast in the Teenage and Transgender Population Breast Cancer in Young Women Case 1 Case 2 Case 3 Bibliography 2: Imaging of the Symptomatic Breast Palpable Abnormalities of the Breast Nipple Discharge Symptoms Related to Nipple Areola Complex Breast Pain Inflammatory Breast Carcinoma (IBC) Symptoms Associated with Breast Implant Complications Axilla Non-tumorous Axillary Masses Bibliography 3: Imaging of the Symptomatic Male Breast Introduction Embryology and Anatomy of the Male Breast Imaging the Male Breast Mammography Ultrasound Breast Magnetic Resonance Imaging Breast Interventional Procedures Benign Diagnoses Gynecomastia Pseudogynecomastia Lipoma Intramammary Lymph Node Pseudoangiomatous Stromal Hyperplasia Epidermal Inclusion Cyst Granulomatous Mastitis Subareolar Abscess Myofibroblastoma Nodular Fasciitis Granular Cell Tumor Hemangioma Male Breast Cancer Invasive Ductal Carcinoma Papillary Carcinoma Invasive Lobular Carcinoma Summary References 4: Management of a Woman at Elevated Risk for Breast Cancer Introduction Identification of the High-Risk Patient Hereditary Cancer Review Under-recognition: The Scope of the Problem Benign Atypical Lesions ADH/ALH/LCIS and FEA Breast Density Therapeutic Irradiation Risk Modeling Gail Model Tyrer-Cuzick Model Barlow/Breast Cancer Surveillance Consortium Claus BRCAPRO BOADICEA/CanRisk Discussion and Clinical Implementation Polygenic Risk Score Risk Management Imaging in High-Risk Patients Screening Mammography: Special Challenges Choosing the Modality: Digital Mammography Versus Digital Breast Tomosynthesis NCCN Criteria for Screening MRI ACR Criteria for Screening MRI in Breast Cancer Survivors FAST/Abbreviated MRI Other Modalities: Ultrasound, Contrast Enhanced Mammography, BSGI, and MBI Future Directions in Breast Imaging Interesting Cases Case 1 Case 2 Case 3 Chemoprevention Tamoxifen and Raloxifene NSABP P-1 Study: The Breast Cancer Prevention Trial STAR Trial Low-Dose Tamoxifen Exemestane Anastrozole Risk-Reducing Surgery Breast Reconstruction Psychological Assessment and Counseling Lifestyle Modifications Modifiable Risk Factors BMI/Exercise Alcohol Breastfeeding Menopausal Hormone Therapy What About Contraception? Conclusion References 5: The Multidisciplinary Approach to Breast Cancer Management Introduction General Considerations Preoperative Multidisciplinary Management Intraoperative Multidisciplinary Management Postoperative Multidisciplinary Management Management of Ductal Carcinoma In Situ Key Clinical Trials Ongoing Trials Selection of Surgical Therapy Breast-Conserving Surgery or Mastectomy Axillary Staging Surgical Technique Breast-Conserving Surgery Mastectomy Radiation Therapy Adjuvant Tamoxifen Management of Early-Stage Breast Cancer Key Clinical Trials Trials Comparing BCT and Mastectomy Axillary Staging Selection of Surgical Therapy of the Primary Tumor BCT or Mastectomy Breast Reconstruction After Mastectomy Management of the Regional Lymph Nodes Surgical Techniques Breast-Conserving Surgery Mastectomy Axillary Lymph Node Surgery Radiation Therapy Systemic Therapy Management of Locally Advanced Breast Cancer Selection of Surgical Therapy Surgical Techniques Breast-Conserving Surgery Mastectomy Axillary Lymph Node Dissection Targeted Axillary Lymph Node Dissection Radiation Therapy Systemic Therapy Surveillance for Breast Cancer Patients Who Have Completed Curative Treatment Guidelines for Follow-Up After Breast Cancer Treatment Actual Practice Patterns NCCN Guidelines for Breast Cancer Survivors References 6: Screening for Breast Cancer Early Detection of Breast Cancer with Mammography: Benefits and Harms Mammographic Signs of Breast Cancer Uncommon Mammographic Signs of Breast Cancer Optimizing Mammographic Interpretation Mammography Quality Standards Act (MQSA) Mandated Mammography Audit Screening Mammography Guidelines for Women at an Average Risk for Breast Cancer Digital Breast Tomosynthesis (DBT) Bibliography 7: Emerging Technologies in Breast Cancer Screening and Diagnosis Supplemental Screening Personalized Risk-Based Screening Functional Imaging: CE-MRI, CE-Mammography (CEM), and CE-CBCT Contrast-Enhanced MRI (CE-MRI) Contrast-Enhanced Mammography (CEM) Contrast-Enhanced Cone-beam Breast CT (CE-CBCT) Artificial Intelligence References 8: Pelvic Pain: Role of Imaging in the Diagnosis and Management Acute Pelvic Pain Imaging Techniques in the Evaluation of a Patient with Acute Pelvic Pain Computed Tomography (CT) Gynecological Causes of Acute Pelvic Pain Adnexal Causes of Acute Pelvic Pain Simple Ovarian Cysts Hemorrhagic Ovarian Cyst Imaging in Ovarian Torsion Pelvic Inflammatory Disease (PID) Ovarian Venous Thrombosis Uterine Causes of Acute Pelvic Pain Hematometra IUD Complications Fibroids Spontaneous Abortion (SAB) Non-gynecological Causes of Acute Pelvic Pain Gastrointestinal Causes of Acute Pelvic Pain Anatomy and Technical Aspects of Ultrasound Assessment of the Bowel Acute Appendicitis Secondary Appendicitis Acute Diverticulitis Omental Infarction Epiploic Appendagitis Small Bowel Ischemia and Hemorrhage Groin Hernias Genitourinary Causes of Acute Pelvic Pain Distal Ureteral Calculus Cystitis Ectopic Pregnancy Ultrasound Imaging in Ectopic Pregnancy Differential Diagnosis Uncommon Location of Ectopic Pregnancies Interstitial Ectopic Pregnancy Cervical Pregnancy Intramural Pregnancy Heterotopic Pregnancy Ovarian Ectopic Pregnancy Cesarean Scar Pregnancy Role of MRI in Ectopic Pregnancy Posttreatment Imaging Chronic Pelvic Pain Chronic PID Endometriosis Introduction Diagnosis and Imaging in Endometriosis Ultrasonography Magnetic Resonance Imaging (MRI) MR Imaging Features Endometriosis of the Ovaries Extraovarian Endometriosis Deep Invasive Endometriosis (DIE) Endometriosis and Malignancy Abdominal Scar Endometriosis Conclusion References 9: Imaging of Abnormal Uterine Bleeding and Menstrual Disorders Introduction The Menstrual Cycle The Hypothalamic-Pituitary-Ovarian Axis The Ovary: Follicular Phase and Luteinizing Phase The Endometrium: Proliferative Phase and Secretory Phase Imaging Modalities Ultrasound MRI Hysteroscopy Pregnancy Miscarriage Ectopic Pregnancy Molar Pregnancy Polyps Imaging Modalities Transvaginal Ultrasonography Color Flow Doppler Saline Infusion Sonography Hysteroscopy, Biopsy, and Endometrial Polypectomy Adenomyosis Imaging Modalities Ultrasonography Magnetic Resonance Imaging Management Leiomyoma Imaging Modalities Ultrasonography Hysteroscopy Magnetic Resonance Imaging Management Myomectomy Uterine Artery Embolization Malignancy and Hyperplasia Endometrial Cancer Ultrasound MRI Cervical Cancer Coagulopathies Von Willebrand Disease Acquired Coagulopathies Ovulatory Dysfunction Hyperprolactinemia Hypothalamic Dysfunction Hypothyroidism Imaging Endometrial Diagnosis Ultrasound MRI Management Iatrogenic IUD Chemotherapy Agents and Steroid Hormones Not Yet Classified Pelvic Inflammatory Disease Imaging Ultrasound Magnetic Resonance Imaging Laparoscopy Vaginal Trauma Foreign Bodies Conclusion References 10: Non-obstetric Complications in Pregnancy: Role of Imaging Radiation Risk Considerations from the Use of Diagnostic Imaging in Pregnancy Pathogenesis of the Diagnostic Radiation Exposure Risks to the Fetus Pathological Effects of Exposure of the Human Embryo to Ionizing Radiation All or None Phenomenon Congenital Malformation and Growth Retardation Neurobehavioral Effects Effects of Protraction and Fractionation Indirect Exposure to Radiation Increased Risk of Leukemia and Other Malignancies Maternal Risk from Radiographic Examination Counseling a Pregnant Patient Regarding Risk of Being Exposed to Diagnostic Radiation Screening for Pregnancy Prior to Radiological Examinations Pregnancy Consent Policy Methods to Reduce Radiation Dose Management of the Patient Not Known to Be Pregnant During the Examination Ultrasonography Imaging in Pregnancy Computed Tomography in Pregnancy Magnetic Resonance Imaging in Pregnancy Imaging in the Evaluation of Non-obstetrical Complications in Pregnancy Common Indications Evaluation of a Pelvic Mass in Pregnancy Ultrasound in the Assessment of a Pelvic Mass MRI Evaluation of an Adnexal Mass MRI Differential Diagnosis of Adnexal Masses Malignancies in Pregnancy Imaging a Pregnant Patient with Abdominal Pain Imaging of Renal Colic in Pregnancy Imaging Algorithm in a Patient with Renal Colic Imaging of Trauma during Pregnancy Radiography Ultrasonography Computed Tomography (CT) Magnetic Resonance Imaging (MRI) References Suggested Reading 11: Pelvic Mass: Role of Imaging in the Diagnosis and Management Uterine Masses Leiomyomas Clinical Considerations Imaging Features of a Fibroid Differential Diagnosis in Patients with an Enlarged Uterus in a Nonpregnant Setting Smooth Tumors of Unknown Malignant Potential (STUMP) Adnexal Masses Ovarian Tumor Lexicon Cystic Tumors of the Ovary Solid Tumors of the Ovary Morphological Patterns of Ovarian Tumors Unilocular Cyst Unilocular Cyst with Solid Components Multilocular Cyst Multilocular Cyst with Solid Components Solid Ovarian Tumors Imaging Pathological Correlation of Ovarian Cancers Borderline Tumors of the Ovary (BOT) Solid Ovarian Cancers Cystic Ovarian Cancers Hormonally Active Ovarian Tumors Doppler Ultrasound Characteristics of Ovarian Tumors Ovarian Tumors: Malignancy Risk Stratification Pattern Recognition Approach IOTA Logistical Regression Models Simple Ultrasound-Based Rules for the Diagnosis of Ovarian Cancer IOTA-ADNEX Model for the Characterization of Different Types of Ovarian Cancers Risk of Malignancy Index Adnexal Tumors Difficult to Classify Non-ovarian Pelvic Mass Cystic Extraovarian Mass Cystic Extraovarian Masses Fallopian Tube Pathology Mimicking Ovarian Tumors Primary Fallopian Tube Carcinoma (PFTC) Imaging Features of PFTC Hematosalpinx Chronic Tubal Pregnancy Chronic Tuboovarian Abscess Extraovarian Endometrioma Peritoneal Inclusion Cysts Paraovarian Cysts Mucocele of the Appendix Rectal Duplication Cyst Spinal Meningeal Cyst Lymphocele Solid Extraovarian Mass Parasitic Fibroid and Broad Ligament Fibroid Extraovarian Fibrothecomas Chronic Pelvic Hematoma Gastrointestinal Stromal Tumors Pelvic Metastasis Supplemental Role of CT and MRI in the Evaluation of Pelvic Masses and in the Staging of Gynecological Malignancies (Saleh, M and Vikram, R, MDACC) Masses Arising from the Uterus Masses Arising from the Uterine Cervix Cervical Carcinoma Adenoma Malignum Masses from the Uterine Corpus Endometrial Carcinoma Ovarian Masses Solid Simple Cystic Ovarian Masses Serous Cystadenoma Complex Cystic Ovarian Masses Teratoma Endometrioma Hemorrhagic Cyst Mixed Adenocarcinoma Clear Cell Carcinoma Endometrioid Carcinoma Metastasis References Suggested Reading 12: Postmenopausal Bleeding: Role of Imaging in the Diagnosis and Management Etiology of Postmenopausal Bleeding Medications That Can Cause Postmenopausal Bleeding Evaluation of Postmenopausal Bleeding (Table 12.3) Imaging of Endometrial Cancer Carcinosarcomas or Malignant Mixed Mullerian Tumors (MMMT) of the Uterus Bibliography 13: Pelvic Floor Dysfunction: Role of Imaging in Diagnosis and Management Transperineal Ultrasonography: Method and Clinical Application Introduction Equipment and Technique Anterior Compartment Pathology Residual Urine and Detrusor Wall Thickness Stress Urinary Incontinence Pelvic Organ Prolapse Anterior Compartment Central Compartment Posterior Compartment The Anal Sphincter Synthetic Implants Slings Prolapse Mesh The Levator Ani Conclusions Take-Home Messages Bibliography 14: Role of Imaging in the Management of Female Infertility Introduction Imaging Modalities for Diagnosis of Infertility Ultrasound Uterine Evaluation Evaluation of Adnexa and Ovaries Saline Infusion Sonography and Sonohysterosalpingography Hysterosalpingography Magnetic Resonance Imaging Hysteroscopy Computed Tomography Conclusion of Use of Imaging in Infertility Workup Management of Infertility Using Imaging Monitoring for IVF and Embryo Transfer Retrieval Transfer Hysteroscopy for the Treatment of Intrauterine Lesions Conclusion of Use of Imaging in Infertility Management References 15: Urinary Tract Infections: Role of Imaging in the Management Introduction Terminology Location Lower Tract Upper Tract Complicated Versus Uncomplicated UTIs Time Course Diagnostic Evaluation Laboratory Evaluation Imaging Evaluation Cystourethroscopy Ultrasound X-Ray Tc-99m DMSA Renal Cortical Scintigraphy CT Imaging MR Imaging Conclusion References 16: Health Economics in Women’s Imaging Radiology-Related Healthcare Policy Different Payors and Payment Systems Current State of the Affairs and Challenges in Healthcare Delivery and Management in the United States Myths and Realities of the US Healthcare System What Is Being Done Today? A Primer for Setting Up an Outpatient Women’s Imaging Center Bibliography Index