Modern Imaging in Breast Cancer

8/10/2019 Modern Imaging in Breast Cancer

1/75

Modern Imaging in Breast

Cancer

Dr Linda Hacking

Consultant Radiologist


2/75

October is Breast CancerAwareness Month

Breast cancer is commonest cancerin UK e!cluding non"melanoma skincancer#

$%&''' new cases (er )ear

*'' men& remainder women

+', o-er .' )ears o/ age 0 in 1 women will get it in their

li/etime


3/75

Bad news23ood news

Incidence has increased b) .', inlast 4.)ears

04&''' women and 5' men died /rombreast cancer in 4''+

0&*'' deaths in women under .'

More than hal/ deaths are in womeno-er 5'


4/75

Bad news23ood news

6ince 01+'s breast cancer death rates ha-e/allen b) one third

Breast cancer is no longer the commonestcause o/ cancer death in women

More than + out o/ 0' women sur-i-e be)ond. )ears . out o/ 0' in 015's#

7ow twice as likel) to sur-i-e 0' )ears as $')ears ago8

4 out o/ * women sur-i-e be)ond 4' )ears

Breast cancer death rates /alling /aster in UKthan rest o/ 9uro(e


5/75

Reasons /or im(ro-ements inoutcomes

6creening

Im(ro-ed treatments :amo!i/en etc# Im(ro-ed cancer ser-ices including

imaging


6/75


7/75

;h) are these im(ro-ementsha((ening

Breast screening


8/75

Breast 6creening

7H6 Breast 6creening =rogramme7H6B6=#

Began 01++"1'

7ot Black(ool >ictoria8

7earest centre Lancaster -ans& ;3D#

In-ited /or Mammograms /rom age .'"%1

9!tended /rom $5"5* )ears /rom 4'04target#

=ast u((er age limit& o(tion to arrangemammogram8


9/75

Breast 6creening

;ill cause increase in incidence o/cancer

9arl) cancers and (re"cancer DCI6#are /ound that would ne-er ha-e ledto a (roblem


10/75

?or Breast 6creening

One woman will be o-er"treated /ore-er) two li-es sa-ed

0''' li-es a )ear sa-ed

Im(act on (o(ulation -s indi-idualwoman@s li/e8


11/75

Against breast screening

0', o/ cancers are o-er"diagnosisand there/ore o-er treatment

It is im(ossible to estimate li-essa-ed because o/ all other /actors

Im(act on (o(ulation -s im(act on

indi-idual woman@s li/e


12/75

:oda) we are talking aboutdiagnosis


13/75

:he 6)m(tomatic BreastClinic

Lum( or thickening

Change in sie or sha(e

Redness or rash in skin or ni((le Indrawing o/ ni((le

6kin (uckering or dim(ling

Lum( in arm(it


14/75

Re/erral to Breast Clinic

Ma) sim(l) need to see seniorclinician" no /urther ad-ice& no/urther in-estigations8

:ri(le assessment2Doubleassessment

6ee 6enior Clinician 0#

Imaging 4#

Bio(s) or needle test ?7A# *#


15/75

Modern Imaging and Bio(s)

:ests to be done at rst clinica((ointment /or most (atients

Most (atients will ha-e a benign diagnosis

Less than 0 in 0' (atients attending ourclinic will ha-e a malignant diagnosis

1 out o/ 0' will be benign

In new clinic& results /or (atients seenMonda)& :uesda) a-ailable /or ?rida)

;ednesda)& within a week


16/75

Modern Imaging and Bio(s)

uick accurate diagnosis /or themaEorit) o/ (atients who will ha-e abenign diagnosis

As much in/ormation as (ossible aboutwhat we are dealing with in theminorit) i/ (atients who ha-e a

malignant diagnosis :reatment can then be tailored to the

indi-idual (atient


17/75

Mammogra(h)

6)m(tomatic (atients

;omen F*. )ears o/ age

Uses !"radiation

In-ented in 01%'s& modern t)(e o/ machine01%1

6till not in uni-ersal use 01+% when I startedin radiolog)#

?irst unit Black(ool 011' ?)lde Coast incl87H6# Black(ool >ictoria Mammogra(h) unit 01118

October 4'0' ?ull ?ield Digital mammogra(h)


18/75


19/75


20/75


21/75


22/75


23/75


24/75


25/75


26/75

Mammogra(h)

=roblems

G"radiation

Dense breasts oung women

Men

Im(lants 7o imaging 0'', accurate


27/75

?ield Digital Mammogra(h)

Better on all counts

Dense breast

ounger women Less radiation


28/75


29/75


30/75


31/75


32/75


33/75

Ultrasound

?irst imaging *.& and men

:o clari/) lum(s and c)sts onmammogram

:o do image guided bio(s)

:o look at a!illa arm(it#


34/75


35/75

C)st


36/75


37/75

Ultrasound guided bio(s)


38/75


7eedle guided into abnormalit)under direct -ision

Can be needle test ?7A#

Or Core bio(s)

Uses local anaesthetic

:akes ."0' minutes

Ja bit like getting ears (ierced

Com(lications" bruising& (ain


39/75


uick -er) accurate results

A (atient s(ecic indi-idual (lan i/surger) reuired

:umour grade i/ malignant Hormone rece(tor status :amo!i/en&

herce(tin#

6ie and e!tent o/ masses# L)m(hnodes

:est done :uesda)& results ?rida)


40/75

Core Bio(s) 7eedle


41/75


M hi i


42/75

Mammogra(hic stereotacticbio(s)

Mass seen on mammogram& not onultrasound

Micro"calcication Jchalk) bits" can be

benign& can be malignant or (re"malignant DCI6#

7o lum( /elt

6tandard core bio(s) >acuum assisted core bio(s)

6(ecial de-ices

M hi t t ti


43/75

Mammogra(hic stereotacticbio(s)

=re-iousl) ma) ha-e needed generalanaesthetic surger) to remo-eabnormalit)

7ow out(atient (rocedure underlocal anaesthetic

Most turn out to be benign


44/75

>acuum assisted bio(s)


45/75


46/75

>acora -s 0$3 bio(s)


47/75

6am(le can be !"ra)ed


48/75


49/75


50/75

B t MR ti


51/75

Breast MR magneticresonance#


52/75

Breast MR

Also maEor in-estment in breast coilsand so/tware /or new MR scanner

Increased com/ort

9ase o/ inter(retation so/tware#


53/75


54/75

Breast MR

Recentl) in (ress

In UK not used in e-er) case

Lobular carcinoma

Multi/ocal carcinoma =roblem sol-ing when

imaging2clinical2(atholog) do not match

Doubts about mastectom)2 local e!cision uestion o/ recurrence

Im(lants


55/75


56/75


57/75


58/75


59/75


60/75


61/75

Breast MRI

Adds to (lanning o/ surger)


62/75

6o /ar

;e ha-e been talking about diagnosis

Imaging also hel(s during surger)


63/75

Localisation o/ mass not /elt

Marker with ultrasound

;ire with stereotactic mammogra(h)

Mass can be !"ra)ed while (atientstill anaesthetised


64/75

9!cised s(ecimen

Also during surger) 6entinel


65/75

Also during surger)"6entinelL)m(h 7ode Bio(s) 6L7B#


66/75

67LB

6mall amount radioacti-it) inEected intobreast

On morning be/ore a/ternoon surger) Or a/ternoon be/ore morning surger) Also blue d)e in theatre 3oes to rst l)m(h node 6urgeon uses (robe in theatre 7o drain& much reduced com(lication rate

com(ared with 7ode Clearance 6eroma& l)m(hoedema& (ain& numbness O-ernight sta) -s se-eral da) sta)


67/75

6L7B

A small (ercentage will reuire/urther surger) once node e!aminedin lab

7odes e!amined with ultrasound and?7A (rior to surger)

7ot suitable /or e-er)one


68/75


69/75

6urgical (robe


70/75

:he ?uture

:omos)nthesis

On table sentinel node diagnosis

Answers about breast screening


71/75

htt(22www8)outube8com2watch


72/75

:o 6ummarise

Black(ool >ictoria has o(ened a brandnew breast clinic

;e ha-e the latest technolog) a-ailable

/or the best (ossible care /or our (atients :he new clinic (athwa) /or ra(id access

and diagnosis will benet all o/ our(atients

Most (atients will ha-e a benigndiagnosis deli-ered uickl)


73/75

?or the /ew (atients whoun/ortunatel) ha-e a malignant

diagnosis :he) will be treated uickl)& with all

o/ the latest technologies a-ailable

;e should be able to u(grade /or the/uture


74/75

:he outlook is good


75/75

:hanks to the team

Documents

Modern Imaging in Breast Cancer