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Current MR Imaging of Breast Cancer, An Issue of Magnetic Resonance Imaging Clinics of North America, E-Book

Current MR Imaging of Breast Cancer, An Issue of Magnetic Resonance Imaging Clinics of North America, E-Book

Jessica W. T. Leung

(2018)

Additional Information

Abstract

This issue of MRI Clinics of North America focuses on Current MR Imaging of Breast Cancer, and is edited by Dr. Jessica Leung. Articles will include: Breast MRI: Atlas of anatomy, physiology, pathophysiology, and BI-RADS lexicon; Neoadjuvant therapy monitoring, including inflammatory breast cancer; Breast MRI biopsy considerations: Technique, histologic upgrading, and radiologic-pathologic concordance; Breast MRI techniques and developments: 1.5 vs 3T, diffusion, fast MRI, PET-MRI, and other developing techniques; ACR Accreditation, Performance Metrics, Reimbursement, and Economic Considerations in Breast MRI; Screening: high-risk and dense breasts, especially compared with tomosynthesis and ultrasound; Extent of breast disease, especially compared with tomosynthesis and ultrasound, with special focus on nodal assessment; Problem-solving tool for imaging finding and clinical symptoms of breast cancer; MRI compared with contrast-enhanced mammography; MRI compared with molecular breast imaging; MRI compared with positron emission mammography; How does MRI help care for my breast cancer patient? Perspective of a surgical oncologist; How does MRI help care for my breast cancer patient? Perspective of a medical oncologist; How does MRI help care for my breast cancer patient? Perspective of a radiation oncologist; and more!

Table of Contents

Section Title Page Action Price
Front Cover Cover
Current MR Imaging ofBreast Cancer i
Copyright\r ii
Contributors iii
CONSULTING EDITORS iii
EDITOR iii
AUTHORS iii
Contents v
Foreword: Breast MR Imaging v
Preface: Breast MR Imaging in Era of Value-Based Medicine v
Breast MR Imaging: Atlas of Anatomy, Physiology, Pathophysiology, and Breast Imaging Reporting and Data Systems Lexicon v
Role of MR Imaging for the Locoregional Staging of Breast Cancer v
Role of MR Imaging in Neoadjuvant Therapy Monitoring v
Problem-Solving MR Imaging for Equivocal Imaging Findings and Indeterminate Clinical Symptoms of the Breast v
MR Imaging–Guided Breast Interventions: Indications, Key Principles, and Imaging-Pathology Correlation vi
Developments in Breast Imaging: Update on New and Evolving MR Imaging and Molecular Imaging Techniques vi
Comparison of Contrast-Enhanced Mammography and Contrast-Enhanced Breast MR Imaging vi
Use of Breast-Specific PET Scanners and Comparison with MR Imaging vi
Comparison of Breast MR Imaging with Molecular Breast Imaging in Breast Cancer Screening, Diagnosis, Staging, and Treatment ... vii
How Does MR Imaging Help Care for My Breast Cancer Patient? Perspective of a Surgical Oncologist vii
How Does MR Imaging Help Care for the Breast Cancer Patient? Perspective of a Medical Oncologist vii
How Does MR Imaging Help Care for My Breast Cancer Patient? Perspective of a Radiation Oncologist vii
American College of Radiology Accreditation, Performance Metrics, Reimbursement, and Economic Considerations in Breast MR I ... viii
MAGNETIC RESONANCE IMAGINGCLINICS OF NORTH AMERICA ix
CME Accreditation Page x
PROGRAM OBJECTIVE x
TARGET AUDIENCE x
LEARNING OBJECTIVES x
ACCREDITATION x
DISCLOSURE OF CONFLICTS OF INTEREST x
UNAPPROVED/OFF-LABEL USE DISCLOSURE x
TO ENROLL x
METHOD OF PARTICIPATION x
CME INQUIRIES/SPECIAL NEEDS x
Foreword:Breast MR Imaging xi
Preface:Breast MR Imaging in Era of Value-Based Medicine xiii
Breast MR Imaging\rAtlas of Anatomy, Physiology,\rPathophysiology, and Breast Imaging\rReporting and Data Systems Lexicon 179
Key points 179
INTRODUCTION 179
ANATOMY 179
THE MR IMAGING BREAST IMAGING REPORTING AND DATA SYSTEMS LEXICON 180
BREAST TISSUE 180
BREAST LESIONS 181
Focus 181
Mass 182
Nonmass Enhancement 182
Benign and Nonenhancing Findings 183
Associated Features 184
KINETIC CURVE ASSESSMENT 185
IMPLANT ASSESSMENT 188
FINAL ASSESSMENT 189
SUMMARY 190
REFERENCES 190
Role of MR Imaging for the Locoregional Staging of Breast Cancer 191
Key points 191
INTRODUCTION 191
Multifocality and Multicentricity of Breast Cancer 191
MR IMAGING DETECTION OF ADDITIONAL DISEASE IN THE IPSILATERAL BREAST 192
CONTRALATERAL DISEASE 193
MR IMAGING COMPARED WITH DIGITAL BREAST TOMOSYNTHESIS FOR LOCAL STAGING 194
MR IMAGING EVALUATION OF NODAL BASINS 195
IMPACT OF BREAST MR IMAGING ON SURGICAL OUTCOMES 196
IMPACT OF MR IMAGING ON MASTECTOMY RATES 198
INVASIVE LOBULAR CARCINOMA 198
Ductal Carcinoma In Situ and Extensive Intraductal Component 199
IMPACT OF MR IMAGING ON RECURRENCE RATES 200
OF MOLECULAR SUBTYPES 201
SUMMARY 201
REFERENCES 201
Role of MR Imaging in Neoadjuvant Therapy Monitoring 207
Key points 207
INTRODUCTION 207
ASSESSMENT OF RESPONSE BY CONVENTIONAL IMAGING 208
IMAGING 209
MR IMAGING PROTOCOL 209
IMAGING SIZE 209
IMAGING MORPHOLOGY 211
IMAGING KINETICS 212
RESPONSE ASSESSMENT USING OTHER MR IMAGING FEATURES 214
IMAGING BY BREAST CANCER SUBTYPE 215
IMAGING IN INFLAMMATORY BREAST CANCER 215
SUMMARY 217
REFERENCES 217
Problem-Solving MR Imaging for Equivocal Imaging Findings and Indeterminate Clinical Symptoms of the Breast 221
Key points 221
INTRODUCTION 221
CLINICAL SYMPTOMS 222
Palpable Lump 222
Breast Pain (Mastodynia) 222
Nipple Discharge 223
EQUIVOCAL IMAGING FINDINGS 224
Mass 224
Calcifications 224
Architectural Distortion 226
Asymmetry 227
Empirical data 228
Surgical scar 228
LIMITATIONS 229
SUMMARY 229
REFERENCES 229
MR Imaging–Guided Breast Interventions 235
Key points 235
INTRODUCTION 235
INDICATIONS FOR MR IMAGING–GUIDED BREAST INTERVENTIONS 235
PREPROCEDURE EVENTS 236
Procedure Planning 236
Patient Preparation and Risks 236
STEPS COMMON TO ALL MR IMAGING–GUIDED BREAST INTERVENTIONS 237
Positioning 237
Targeting 237
Intervention 237
Postintervention Care 237
MR IMAGING–GUIDED BIOPSY 238
Place the Biopsy Device 239
Sampling 239
Confirm the Adequacy of Sampling 240
Approach to Difficult Lesions 240
MR IMAGING–GUIDED CLIP PLACEMENT 240
MR IMAGING–GUIDED NEEDLE LOCALIZATION 240
IMAGING-PATHOLOGY CORRELATION AFTER MR IMAGING–GUIDED BIOPSY 242
Management of Lesions with Imaging-Concordant Benign Pathology Results 243
Management of Lesions with Imaging-Concordant High-Risk Pathology Results 244
SUMMARY 244
REFERENCES 245
Developments in Breast Imaging 247
Key points 247
INTRODUCTION 247
MR IMAGING 247
Magnetic Field Strength: 3 T Versus 1.5 T 248
MR imaging protocol at 3 T 248
Advantages of 3 T imaging 248
Disadvantages of 3 T imaging 248
Diffusion-Weighted Imaging 248
Technical considerations 249
Clinical use 249
Monitoring neoadjuvant chemotherapy 249
Evaluation of the axilla 249
Abbreviated MR Imaging 250
Abbreviated MR Imaging protocols 250
Upcoming clinical trials and future directions 252
Molecular Imaging Techniques 252
Breast-specific γ-imaging 252
Positron emission mammography 253
PET and MR Imaging 253
PET and MR imaging and the evaluation of breast lesions 254
PET and MR imaging, and known disease 254
Local tumor staging 254
Distant metastatic disease 254
Treatment response 255
Technical challenges 255
SUMMARY 255
ACKNOWLEDGMENTS 255
REFERENCES 255
Comparison of Contrast-Enhanced Mammography and Contrast-Enhanced Breast MR Imaging 259
Key points 259
INTRODUCTION 259
IMAGING TECHNIQUE 259
IMAGING PROTOCOL 260
MAMMOGRAPHY AND MR IMAGING 260
MAMMOGRAPHY VERSUS MR IMAGING 261
POTENTIAL APPLICATIONS OF CONTRAST-ENHANCED MAMMOGRAPHY 263
SUMMARY 263
REFERENCES 263
Use of Breast-Specific PET Scanners and Comparison with MR Imaging 265
Key points 265
INTRODUCTION 265
BREAST-SPECIFIC PET DEVICES 265
IMAGING PROTOCOL AND RADIATION EXPOSURE 267
LOCAL EXTENT OF DISEASE 268
AXILLA 269
QUANTIFICATION 269
BACKGROUND 18F-2-DEOXY-2-FLUORO-D-GLUCOSE UPTAKE AND BREAST DENSITY 269
RESPONSE TO PRIMARY CHEMOTHERAPY 270
OTHER APPLICATIONS 270
SUMMARY 270
REFERENCES 271
Comparison of Breast MR Imaging with Molecular Breast Imaging in Breast Cancer Screening, Diagnosis, Staging, and Treatment ... 273
Key points 273
INTRODUCTION 273
MOLECULAR BREAST IMAGING SYSTEMS 274
BREAST MR IMAGING AND MOLECULAR BREAST IMAGING IN BREAST CANCER SCREENING 274
BREAST MR IMAGING AND MOLECULAR BREAST IMAGING IN BREAST CANCER DIAGNOSIS 275
BREAST MR IMAGING AND MOLECULAR BREAST IMAGING IN BREAST CANCER STAGING 276
BREAST MR IMAGING AND MOLECULAR BREAST IMAGING FOR PREDICTION OF RESPONSE TO NEOADJUVANT CHEMOTHERAPY 277
ADDITIONAL CONSIDERATIONS: BIOPSY, COST, RADIATION EXPOSURE, AVAILABILITY, AND PATIENT COMFORT 278
SUMMARY 278
REFERENCES 278
How Does MR Imaging Help Care for My Breast Cancer Patient? Perspective of a Surgical Oncologist 281
Key points 281
INTRODUCTION 281
MR Imaging Sensitivity 282
USE OF MR IMAGING IN PATIENTS WITH CANCER 282
Staging of the Primary Tumor 282
Contralateral Breast Cancer 283
Occult Primary Breast Cancer 283
Paget Disease 284
USE OF MR IMAGING IN PATIENTS WITHOUT CANCER 284
High-Risk Screening 284
DISADVANTAGES OF MR IMAGING 285
SUMMARY 285
REFERENCES 286
How Does MR Imaging Help Care for the Breast Cancer Patient? Perspective of a Medical Oncologist 289
Key points 289
INTRODUCTION 289
Detection of Additional Disease in the Newly Diagnosed Patient with Breast Cancer 290
Tumor Vascularity and Ductal Carcinoma In Situ in Upstaging Disease 290
Breast Cancer Subtypes 290
Predicting Tumor Response 290
Staging Metastatic Disease 291
Breast Cancer Presenting as Unknown Primary Tumor 291
SUMMARY 291
REFERENCES 292
How Does MR Imaging Help Care for My Breast Cancer Patient? Perspective of a Radiation Oncologist 295
Key points 295
INTRODUCTION 295
EARLY-STAGE PATIENTS 296
Patient Selection for Accelerated Partial Breast Irradiation 296
Postoperative Delineation for Accelerated Partial Breast Irradiation or External Beam Boost 297
Defining the Preoperative Accelerated Partial Breast Irradiation Target 298
ADVANCED-STAGE PATIENTS 299
Identification of Locally Advanced Disease: Extensive Lymphatic Spread/Sternal Involvement 299
Identification of Locally Advanced Disease: Skin Thickening/Inflammatory Breast Cancer 300
RADIATION SIDE EFFECTS 300
SUMMARY 301
REFERENCES 301
American College of Radiology Accreditation, Performance Metrics, Reimbursement, and Economic Considerations in Breast MR I ... 303
Key points 303
INTRODUCTION 303
ACCREDITATION OVERVIEW 303
Background 303
Personnel 304
Technical Considerations 304
Peer Review 304
EVALUATING PERFORMANCE 307
Medical Outcome Audit 307
Performance Metrics 308
ECONOMIC CONSIDERATIONS 309
Cost-Effectiveness of Screening 309
Competing Modalities 311
Price Transparency 311
SUMMARY 312
REFERENCES 312