dr. masciotra case of the day n.1 - breast cancer
TRANSCRIPT
Antonio Pio MasciotraCampobasso – Molise – Italy
Website www.masciotra.net
YouTube channelhttps://www.youtube.com/channel/UCgCj21nKGAhR997Ia3-QegQ
dr. MasciotraCase of the day n.1
06/02/2014
50 years old woman No familiar history for
breast cancer Menarche at age of 14
years 2 normal pregnancies
with 18 monthsoverall breastfeeding
Actually in menopausesince 6 months
This mammography wasdone 1 year ago,considered normal,besides very dense breasttissue
10/02/2015
2 months ago she feltsomething strange,sligthly painful in upperouter quadrant of herleft breast
This mammography hasbeen done today
06/02/2014 10/02/2015
Images of left breastaxillary tail in the 2exams are shown incomparison
The nodule in very densebackground shows anincrease in its density,almost doubling of itsvolume, but it seemsaround 1 cm
Left breast 3D US
Skin and preglandular fat
Glandular tissue
Retroglandular fat tissue
Pectoral muscle and fascia
Cancer
Skin and preglandular fat
Glandular tissue
Retroglandular fat tissue
Pectoral muscle and fascia
Cancer
Left breast 3D US
Right breast MRI
Skin and preglandular fat
Glandular tissue
Retroglandular fat tissue
Pectoral muscle and fascia
Left breast MRI
Skin and preglandular fat
Glandular tissue
Retroglandular fat tissue
Pectoral muscle and fascia
Cancer
At mammography and MRI the cancer seems far from skin and pectoralfascia
3D US give large higher morphological and spatial details, showing thatthe posterior margin of the cancer is at only 1.3 mm from the pectoralfascia
At US the nodule is large wider than inmammography (3 cm vs 1 cm)
At shear wave elastography the stifftissue extends beyond the boundariesof the nodule as seen in bidimensionalimage and the mean stiffness is around100 kPa
At least 2 axillary nodes show marginalnodule deforming the capsula, highlysuggestive for embolic metastasis
At shear wave elastography the stiffnessof the node is homogeneous, with meanvalue of around 16 kPa, large lower thanthe 100 kPa of the primitive cancer
At least 2 axillary nodes show marginalnodule deforming the capsula, highlysuggestive for embolic metastasis
At shear wave elastography the stiffnessof the node is homogeneous, with meanvalue of around 16 kPa, large lower thanthe 100 kPa of the primitive cancer
At Color, Directional Powerdoppler andPowerdoppler Imaging the feedingvessels of the cortical nodule are clearlyshown
Keypoints of the case and ‘take home messages’
One more time high breast density is an absolute risk factor for br. ca. by itself and often hides thecancer
This is the reason why an objective volumetric breast density measurement tool (Volpara) had to beused for the quantification of the breast cancer risk and the best planning of the modalities to beused in the screening of these women (considering the very low sensitivity shown by mammography)by adding volumetric US and/or MRI
One more time the size of a cancer at mammography in dense breast is smaller than the one shownby Bidimensional US (echogenicity based) and by SWE (mechanical properties of tissue based).
SWE shows that the cancer is even larger than in US B-scan and at MRI too (hence the question onwhich one of these modalities is the more 'realistic' to correctly grade the 'T' feature in the TNMstaging).
Very stiff primitive breast cancers not necessarily give stiff axillary nodes mets
Axillary nodes status is possibly best assessed by high quality B-scan and CDI of the nodal vessels(density, morphology, distribution and perhaps spectral analysis of the flow).
Antonio Pio MasciotraCampobasso – Molise – Italy
Website www.masciotra.net
YouTube channelhttps://www.youtube.com/channel/UCgCj21nKGAhR997Ia3-QegQ
dr. MasciotraCase of the day n.1
Thanks for your attention