Intermediate Biomarkers

A key element in the control and prevention of invasive breast cancer is the recognition of early, preclinical changes with or without associated characteristic molecular abnormalities that may identify a woman as being at high risk for development of the disease.39 These alterations, called intermediate biomarkers, may be used as SEBs and provide a more cost-effective and rapid means of testing chemopreventive interventions. To date, the most specific intermediate biomark-ers for invasive...

Bilateral Breast Reconstruction

Indications for contralateral prophylactic mastectomy include a strong family history of breast cancer, positive genetic testing, lobular carcinoma in situ (LCIS), cancer anxiety, and equivocal or progressively difficult clinical and or radiographic examinations. With improvements in breast cancer screening, a greater number of early breast cancers are being detected in young, premenopausal patients, many of whom have some degree of familial cancer history. Patients with young families present...

Invasive Breast Carcinoma

Invasive (infiltrating) breast carcinoma can be broadly subdivided into ductal and lobular categories, with a number of recognized variants of each. Although current evidence suggests that the majority of invasive cancers arise from cells of the terminal duct lobular unit, their wide variation in appearance and clinical pre- Figure 5-6. Lobular carcinoma in situ. The acini are filled and distended by a monotonous proliferation of small cells with bland nuclear features (original magnification...

Genetics Natural History and DNABased Genetic Counseling in Hereditary Breast Cancer

LYNCH, BSN The extraordinary advances in molecular genetics during the past decade have established beyond doubt that there is a Mendelian inherited basis for a subset of virtually all forms of cancer.1 Specifically, more than 30 hereditary cancer syndromes have been shown to harbor germ-line mutations. These culprit molecular genetic factors include oncogenes such as the RET proto-oncogene for the multiple endocrine neoplasia type 2 syndromes, the mismatch repair...

Needle Localization Breast Biopsy

The gold standard with which image-guided percutaneous breast biopsy is compared is the needle or wire localization open surgical breast biopsy. However, this traditional management of a suspicious nonpalpable breast abnormality is not without its own error rate. The inability to successfully remove the appropriate lesion ranges from 0.5 to 17 percent.10-15 Some of the reasons given for unsuccessful biopsies include (1) poor radiologic placement of the localization wire, (2) preoperative and...

References

Ernster VL, Barclay J, Kerlikowske K, et al. Inci dence of and treatment for ductal carcinoma in situ of the breast. JAMA 1996 275 913-8. 2. Grisotti A. Conservative treatment of breast can cer. In Spear S, editor. The breast principles and art. Philadelphia Lippincott-Raven 1998. p. 137. 3. Goldwyn RM. Vincenz Czerny and the begin nings of breast reconstruction. Plast Reconstr Surg 1978 61 673-81. 4. Georgiade G, Georgiade N, McKarty KS Jr, et al. Rationale for immediate reconstruction of the...

Role Of Surgery After Induction Chemotherapy

Since the mid-1970s, patients with LABC treated at The University of Texas M. D. Anderson Cancer Center have received three to four cycles of doxorubicin-based combination chemotherapy prior to local therapy local therapy is followed by the completion of systemic therapy and irradiation. Between 1974 and 1996, patients with LABC were treated in four trials addressing four major concerns about the use of induction chemotherapy (1) whether tumor progression will occur during induction...

Reconstruction Of The Partial Mastectomy Defect

Breast conserving surgery combined with adjuvant radiation has been accepted as a regime equivalent to modified radical mastectomy for early stage (I and II) breast cancer. The technique is popular due to its ability to eradicate breast cancer while preserving a maximal volume of breast tissue. Skin incisions are designed directly over the lesion, and skin and subcutaneous tissues are preserved unless involved in the lesion. Closure involves subcuticular closure only and the Figure 11-10....

Leptomeningeal Carcinomatosis

Involvement of the leptomeninges occurs in up to 5 percent of patients with breast cancer, usu ally in the setting of disseminated, progressive disease.25 As mentioned above, this complication is more commonly observed in patients with infiltrating lobular cancer. The majority of patients will present with neurologic signs referable to some combination of cerebrum, cranial nerves, and spinal cord, although the patient may complain only of a single symptom.26 The single-most common complaint is...

Breast Imaging Reporting And Data Systems

To improve the quality of mammography reporting and early breast cancer detection, a consortium of medical experts has developed the Breast Imaging Reporting Data System (BIRADS).6 The American College of Radiology (ACR), in collaboration with the National Cancer Institute, the Centers for Disease Control and Prevention, the Food and Drug Administration, the American Medical Association, the American College of Surgeons, and the College of American Pathologists, created BIRADS to standardize...

Breast Calcifications

The presence of suspicious microcalcifications on a mammogram can make possible the early diagnosis of clinically occult breast cancer. Since the description of calcifications on radiographs of breast cancer by Leborgne in 195115 there have been substantial improvements in the mammo- graphic detail of this finding as well as greater awareness of its importance. Current mammographie techniques can detect calcification in as many as 50 percent of all breast cancers.16 Screening studies have shown...

Radiotherapy Complications

Dosimetric analyses of historic treatment techniques show an average of 25 percent of the cardiac volume received at least 50 percent of the prescribed dose. With modern treatment energies, 5.7 percent of the cardiac volume receives this same dose.124 Serum troponin measurements during radiotherapy, a measure of cardiac injury, revealed no significant elevation in one study.125 Patients treated for left-sided tumors who also had internal mammary nodes treated with modern techniques were...

Specimen Handling And Reporting

Frozen section is entirely appropriate, however, when confirmation of invasive tumor is necessary prior to concurrent axillary dissection or when the surgeon requires intraoperative margin assessment. The popularity of sentinel node techniques using frozen section to determine whether to proceed with axillary dissection is also increasing. In general, all lumpectomy and re-excision specimens must be assessed, at a minimum, for tumor size, tumor type, and margin width. This...

Imaging Specific Types of Infiltrating Breast Cancer

Approximately 85 percent of breast carcinomas arise from ductal structures, with the remaining 15 percent arising from lobular structures. Infiltrating ductal carcinoma accounts for the largest group of breast cancers, representing 65 to 80 percent of cases.10 The classic mammo-graphic presentation of infiltrating ductal carcinoma is a high-density mass with spiculated margins Figure 3-3A . Sonographically, this lesion is typically seen as a shadowing, hypo-echoic mass with irregular margins...

Difficulties In Stereotactic Breast Biopsies

Pre Post Fire Error Biopsy

It is important for the physician to anticipate that some patients and some lesions will be difficult for obtaining biopsy specimens. Certain lesion characteristics, such as low-density nodules, faint or nonclustered microcalcifications, or vague asymmetric densities, may be difficult to visualize with digital imaging despite postprocessing features. The position of certain lesions, such as those that are very superficial, those against the chest wall, or those in the axillary tail of the...

Evaluation Of The Conservatively Treated Breast

Mammography is an essential tool for monitoring conservatively treated breast cancer patients. Recognizing the distinctions between mammo-graphic appearance of the expected postsurgical, postradiation developments and that of recurrent carcinoma is critical for patient care. Magnification mammography is useful after surgery to ensure complete excision of the malignant lesion. If the targeted lesion and all tumor-related calcifications are not clearly included on the specimen radiograph, or if...

Mammographic Appearance Of Breast Cancer

Breast cancer has numerous clinical and imaging presentations. The classic mammographic appearance of infiltrating breast cancer is an irregular mass, often with ill-defined or spiculated margins. In addition to a discrete mass, the invasive tumor can also present as a subtle asymmetric density or an architectural distortion. Clustered pleomorphic calcifications are the common presentation of in situ carcinoma that may or may not be associated with invasive disease. Secondary signs of...

Papillary Carcinoma

Papillary carcinoma accounts for 1 to 2 percent of newly diagnosed breast cancers in women, and a slightly higher proportion in men.1-2-3 It occurs in both an invasive and noninvasive form. The World Health Organization WHO defined papillary carcinoma as follows A rare carcinoma whose invasive pattern is predominantly in the form of papillary structures. The same architecture is usually displayed in the metastases. Frequently, foci of intraductal papillary growth are recognizable.4 Further, the...

Apocrine Carcinoma

Apocrine Carcinoma Skin

Apocrine carcinoma of the breast reportedly accounts for 0.4 percent of new mammary malignancies.2021 This tumor derives its name Figure 6-3. Metaplastic carcinoma with cartilagenous differentiation original magnification x400 . Figure 6-3. Metaplastic carcinoma with cartilagenous differentiation original magnification x400 . from the apocrine glands normally present in skin. Apocrine carcinomas of the breast, however, do not originate from apocrine glands of the skin. Apocrine carcinomas...

Overview

Breast cancer is a highly prevalent and morbid disease, afflicting approximately 1 in 9 women in the United States. The death rate from breast cancer in the United States has recently declined for most age groups, although it remains a major killer with 45,000 deaths annually.1 Despite the overall decline, the incidence of ductal carcinoma in situ DCIS and stage I disease has risen significantly. In parallel, therapeutic opportunities both traditional and alternative for breast cancer patients...