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Modern Imaging in Breast
Cancer
Dr Linda Hacking
Consultant Radiologist
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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
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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'
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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
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Reasons /or im(ro-ements inoutcomes
6creening
Im(ro-ed treatments :amo!i/en etc# Im(ro-ed cancer ser-ices including
imaging
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;h) are these im(ro-ementsha((ening
Breast screening
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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
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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
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?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
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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
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:oda) we are talking aboutdiagnosis
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: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
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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# *#
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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
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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
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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)
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Mammogra(h)
=roblems
G"radiation
Dense breasts oung women
Men
Im(lants 7o imaging 0'', accurate
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?ield Digital Mammogra(h)
Better on all counts
Dense breast
ounger women Less radiation
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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#
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C)st
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Ultrasound guided bio(s)
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Ultrasound guided bio(s)
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
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Ultrasound guided bio(s)
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)
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Core Bio(s) 7eedle
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Ultrasound guided bio(s)
M hi i
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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
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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
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>acuum assisted bio(s)
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>acora -s 0$3 bio(s)
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6am(le can be !"ra)ed
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B t MR ti
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Breast MR magneticresonance#
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Breast MR
Also maEor in-estment in breast coilsand so/tware /or new MR scanner
Increased com/ort
9ase o/ inter(retation so/tware#
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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
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Breast MRI
Adds to (lanning o/ surger)
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6o /ar
;e ha-e been talking about diagnosis
Imaging also hel(s during surger)
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Localisation o/ mass not /elt
Marker with ultrasound
;ire with stereotactic mammogra(h)
Mass can be !"ra)ed while (atientstill anaesthetised
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9!cised s(ecimen
Also during surger) 6entinel
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Also during surger)"6entinelL)m(h 7ode Bio(s) 6L7B#
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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)
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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
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6urgical (robe
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:he ?uture
:omos)nthesis
On table sentinel node diagnosis
Answers about breast screening
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htt(22www8)outube8com2watch
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: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)
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?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
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:he outlook is good
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:hanks to the team
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