Tabar / Tot / Dean Breast Cancer - The Art and Science of Early Detection with Mammography

Perception, Interpretation, Histopathologic Correlation
1. Auflage 2004
ISBN: 978-3-13-257823-4
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 484 Seiten, ePub

Reihe: Tabar Mammo

Early detection is our most effective means for reducing the number of unnecessary deaths caused by breast cancer; however, the lack of skilled mammographic readings, especially in early stage breast cancer, makes this a less effective tool than it could be. In this book, one of the world's most renowned mammographers shares his decades of experience in the analysis and interpretation of mammographic images.

With Dr. Tabar's clear procedures and expert guidance, you will learn to discern the most subtle of pathologic changes to ensure that patients receive optimal and timely treatment. You will also improve your ability to recognize the full range of normal anatomic variability, avoiding unnecessary additional imaging and interventional procedures.

This book contains more than 1,600 high-definition images, many in full-color, to demonstrate anatomic structures, variations in normal tissue, and difficult-to-identify abnormalities. You will also appreciate clear photographs of pathologic specimens, including subgross 3-D, and large, thin-section histologic sections, correlated with mammographic images.

The result of more than two decades of intensive clinical experience, this is the ultimate mammographic atlas for developing expert interpretive skills. No radiologist or breast imager should be without this highly instructive professional reference.

Zielgruppe

Ärzte

Autoren/Hrsg.

Tabar, Laszlo

Tot, Tibor

Dean, Peter B.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Gynäkologie, Geburtshilfe
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Onkologie, Krebsforschung
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Innere Medizin

Inhaltsverzeichnis

Introduction—The Normal Breast: Comparative Subgross Anatomy and Mammography
Chapter 1: Pattern I
Chapter 2: Pattern II
Chapter 3: Pattern III
Chapter 4: Pattern IV
Chapter 5: Pattern V
Chapter 6: Finding Breast Cancer When It Is Still Small: Rationale and Scientific Evidence
Chapter 7: Finding Breast Cancer When It Is Still Small: Use of Systematic Viewing Methods
Chapter 8: Large-Section Histology of the Breast
Chapter 9: Mammography Positioning Technique

Leseproben

Introduction:
The Normal Breast: Comparative Subgross Anatomy and Mammography
Introduction—The Normal Breast: Comparative Subgross Anatomy and Mammography
Diagnosis and treatment of breast cancer in its earliest detectable phases results in dramatic improvement in the outcome of the breast cancer patient. Detection of the disease in its preclinical phase requires regular screening of asymptomatic women. The vast majority of mammograms are images of normal breast tissue. An understanding of how the underlying anatomical structure, in all its complexity and variability, is imaged on the mammogram is necessary for competence in excluding malignancy. This book was written to help the reader accomplish the following goals: • To increase specificity through greater confidence in recognizing normal anatomy. This will enable the radiologist to avoid unnecessary call-backs, additional imaging, and interventional procedures. • To increase sensitivity through improved skill in discerning subtle pathological changes. • To improve diagnostic performance with the ultimate aim of decreasing anxiety among those who do not have breast cancer, and improving the outcome of breast cancer patients through detection and treatment in the preclinical phase. As in other branches of radiology, we need to understand the detailed anatomy of the organ we are imaging as well as the capabilities and limitations of the imaging methods we use. It is our firm belief that competence in breast image interpretation can be best achieved by correlating the histology of the normal and abnormal breast with mammograms, ultrasound and other breast imaging methods. The importance of such correlation is reflected throughout this book. As was eloquently expressed by Ingleby and Gershon-Cohen in 1960: “Very thorough knowledge of breast anatomy and pathology is a sine qua non for interpretation of breast films.”2 The continuously improving resolution in mammographic technique enables us to demonstrate breast abnormalities at earlier phases of their natural history. The different sub-types of in situ carcinoma, hyperplastic breast changes, and borderline lesions are detected at a far greater frequency than they were only two decades ago. The mammogram also helps estimate the extent of the disease, information crucial for the therapist. Diagnostic imaging advances have placed new demands on the pathologist as well. The many large-section histology images presented in this book serve to emphasize the necessity for modifying current histopathological technique to improve communication among pathologists, radiologists, surgeons, and oncologists. The gap between the resolution of the mammogram and the resolution of the microscopic image can be bridged. The subgross, thick-section (three-dimensional) histo-logical technique is an extremely useful tool for helping radiologists, surgeons, and pathologists to understand the nature and extent of the underlying pathological processes. We have used this technique in many cases and these images have been included wherever appropriate. Figures I.1 to I.5 demonstrate the interrelationship between large-section histology, subgross, thick-section histology, and the mammographic image. Comparison of mammograms and 3-D histologic images with photographs of plants and other objects are included where appropriate. There are surprising functional and structural similarities among various biological entities. Demonstration of these similarities facilitates the learning process. Interrelationship Between Histology and Mammography
Fig. I.1-1 Microfocus magnification mammogram. Architectural distortion has altered the harmonious structure of normal breast tissue. The radiating structure does not contain straight, individually recognizable spicules and lacks a central tumor mass. Instead, there are several small, central lucencies. This mammographic image is characteristic of a radial scar. Fig. I.1-2 This subgross, thick-section histological image shows the proliferating ducts arranged in a radiating fashion, accounting for the architectural distortion on the mammogram. Histological diagnosis: radial scar. Fig. I.1-3 Large-section histological image of the radial scar, orcein elastic stain. The collagen stains red, while the elastic fibers stain black. Fig. I.1-4 Large-section histological image of the radial scar; H&E stain. Fig. I.1-5 Large-section histological image of the radial scar; sirius red stain. Mammographic–Subgross Histological Images of the Skin and Areola Fig. I.2-1 Photograph of the nipple–areola complex. Fig. I.2-2 Radiograph of a mastectomy specimen slice demonstrating the skin, nipple, and part of the areolar region. Fig. I.2-3 Subgross, thick-section histological image of the nipple surface. Fig. I.2-4 Subgross, thick-section histological images of sebaceous glands in the areola. Fig. I.3-1 to 3 Subcutaneous tissue with a sweat gland and its duct originating in the skin of the areola. The areas outlined by the rectangles are enlarged on Fig. 1.3-2 and 1.3-3. The Lobar Anatomy of the Breast The female breast has about 12–15 lobes, each terminating in a major duct that empties into the nipple. Fig. I.4 Colored wax was injected into the ducts by Cooper to outline the individual lobes. This image demonstrates that the lobes have different sizes and that they do not anastomose with each other, although they interdigitate. Galactography confirms this observation. There is no distinct anatomical or surgical boundary between the lobes. (Source: Cooper AP. On the Anatomy of the Breast. London, Longmans, 1840. Plate VI, Fig. 3). Fig. I.5-1 & 2 An excellent overview of the ductal system of a single lobe can be seen on the galactogram with the help of positive contrast media. Fig. I.6-1 Subgross, thick-section histological image of a subsegmental duct with normal terminal ductal lobular units (TDLUs). Note the striking similarity to the California cedar. Fig. I.7 Subgross, thick-section histology showing atrophic ducts and lobules in the retroareolar area. Fig. I.8-1 & 2 Occasionally the ducts and some of the lobules within a lobe will be seen on the mammogram outlined by air (negative contrast medium). The surrounding fibrosis enhances the visibility of the air-filled ducts. Fig. I.9 The positive contrast medium on the galactogram outlines the atrophic ducts and their branches. The size and extent of individual lobes vary widely, often extending well beyond the boundaries of a single quadrant. Galactograms in Figures I.10 to I.18 demonstrate some of these variations. Fig. I.10-1 to 4 Bilateral galactograms of the same patient demonstrate variations in the size and extent of the lobes. Figures I.11 to I.14 illustrate further galactographic demonstrations of normal breast lobes. Figures I.15 to I.18 show smaller lobes with distended, fluid-filled ducts caused by multiple papillomas and duct-ectasia. Although the ducts and lobules of one lobe tend to be localized within a volume of approximately one quadrant, the ducts of a single lobe may occupy portions of two or even three quadrants. This galactogram in the craniocaudal projection shows the ductal structure of one lobe spreading over both the medial and lateral portions of the breast (Fig. I.19-1). This illustration suggests that the appearance of two or more seemingly independent tumor foci could still be located within a single lobe, bringing the term multi-centricity into question (see Fig. I.21-1 to 9). Also, ipsilateral recurrences in such a lobe could be found far from the site of resection. If the genetic transformation to breast cancer is localized to the epithelial cells of the diseased lobe, it follows that recurrence of the disease will appear in the remainder of the lobe after partial resection. Malignant tumors most often recur near the site of resection, but they can also recur at more distant sites within the same lobe. Fig. I.20 Mammographic demonstration of a large lobe occupying more than one quadrant of the breast. First screening examination of a 40-year-old asymptomatic woman. Detail of the right CC projection shows innumerable casting-type calcifications characteristic for Grade 3 DCIS. The calcifications outline the duct system of a single lobe, spreading over a large part of the...

Über Autor(innen)

Tabar, Tot, Dean