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SYB 1

SYB 1. Erin Gundersen MS IV. Breast Cancer . Main Types. In Situ- tumor cells confined to ducts and lobules with no invasion Ductal Calcifications Palpable mass Lobular Not palpable, no mammographic appearance Incidental finding Increase risk of invasive cancer. Main Types.

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SYB 1

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  1. SYB 1 Erin Gundersen MS IV

  2. Breast Cancer 

  3. Main Types • In Situ- tumor cells confined to ducts and lobules with no invasion • Ductal • Calcifications • Palpable mass • Lobular • Not palpable, no mammographic appearance • Incidental finding • Increase risk of invasive cancer

  4. Main Types • Invasive Carcinoma- invade breast stroma, can spread or metastasize • Infiltrating ductal — 76 percent • Invasive lobular — 8 percent • Ductal/lobular — 7 percent • Mucinous (colloid) — 2.4 percent • Tubular — 1.5 percent • Medullary — 1.2 percent • Papillary — 1 percent

  5. Mammography • Spiculated soft tissue mass • Most specific- 90% are invasive CA • Clustered microcalcifications- 0.1 to 1 mm in diameter, and numbering more than 4 to 5 per cubic centimeter • Intraductal necrotic tumor • DCIS • Mucin-secreting tumors • Benign- vascular, skin, rim-like, coarse, smooth round or oval

  6. BIRADS diagnostic categories  0- need additional testing 1- negative 2- benign finding 3- probably benign finding 4- suspicious 5- highly suggestive of malignancy 6- biopsy proven carcinoma

  7. Limitations of Mammography • Technique and positioning error • Density of breast tissue • Error in reading • Slow growing tumor

  8. Ultrasound • Uses • Cystic from solid lesions • U/S guided biopsy • Limitations • Not see microcalcification • Miss part of breast tissue

  9. Applications of MRI Screening tool in patients with genetic or familial predisposition Staging of breast cancer Determination of recurrent/residual disease Determination of occult disease

  10. Limitations of MRI • Enhancement during luteal phase • Enhancement with hormone therapy • Difficulty distinguishing benign from malignant • May miss DCIS or invasive lobular

  11. Conclusion • Mammography, ultrasound, and MRI can be used to evaluate breast cancer • Each modality has advantages and limitations • MRI is an evolving diagnostic tool

  12. References Laura J Esserman, MD, MBA. "Diagnostic evaluation and initial staging work-up of women with suspected breast cancer." Uptodate. 31 May 2008. 6 Oct. 2008 <http://www.uptodateonline.com/online/content/topic.do?topickey=breastcn/13029&selectedtitle=1~5&source=search_result#1>. Mieke Kriege, M.Sc., Cecile T.M. Brekelmans, M.D., Ph.D., Carla Boetes, M.D., Ph.D., Peter E. Besnard, M.D., Ph.D., Harmine M. Zonderland, M.D., Ph.D., Inge Marie Obdeijn, M.D., Radu A. Manoliu, M.D., Ph.D., Theo Kok, M.D., Ph.D. "Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition." Nejm 351 (2004): 427-37. Shinil K. Shah, BS, Shiwan K. Shah, BS, and Kathleen V. Greatrex, MD. "Current Role of Magnetic Resonance Imaging in Breast Cancer: A Primer for the Primary Care Physician." JABFM 18 (2005): 478-90.

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