Benign Breast Diseases: Radiology - Pathology - Risk Assessment PDF
Preview Benign Breast Diseases: Radiology - Pathology - Risk Assessment
Catherine N. Chinyama Benign Breast Diseases Radiology Pathology Risk Assessment Second Edition 123 Benign Breast Diseases Catherine N. Chinyama Benign Breast Diseases Radiology - Pathology - Risk Assessment Second Edition Catherine N. Chinyama , MB ChB (Hons), FRCPath, IFCAP, LLM Consultant Pathologist Princess Elizabeth Hospital Le Vauquiedor St. Martin’s Guernsey Channel Islands UK Honorary Clinical Senior Lecturer Brighton and Sussex Medical School Brighton England UK ISBN 978-3-642-41064-2 ISBN 978-3-642-41065-9 (eBook) DOI 10.1007/978-3-642-41065-9 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2013957064 © Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) In memory of my parents Nora and James Chinyama Prefa ce I The majority of textbooks on breast disease understandably concentrate on cancer and related prognostic factors, with minimal space devoted to benign conditions. With widespread use of screening mammography and improve- ments in imaging equipment, smaller and smaller cancers are being detected. This has also resulted in detection of indeterminate micro-calcifi cation and soft tissue densities, which invariably leads to diagnostic fi ne needle aspira- tion cytology or needle core biopsy. Although most of the mammographically indeterminate lesions are benign, biopsies also detect potentially malignant lesions, which include atypical hyperplasias, lesions of undetermined malig- nant potential such as columnar cell change and other epithelial prolifera- tions. These lesions require proper radiological and pathological assessment at multidisciplinary meetings for appropriate patient management. The objective of this book is to provide an overview of radiological and pathological features of benign lesions with an emphasis on screen-detected lesions, with illustrated examples. Although the radiological and pathological correlations concentrate on the screen-detected benign lesions, it was not possible to limit the discussion of the radiology and pathology to just screen- detected lesions. This is because mammographic screening became routine in developed countries only in the past few decades, and there are insuffi cient follow-up data in the literature on patients with screen-detected benign dis- ease. Secondly, although breast disease is arbitrarily classifi ed into symptom- atic and screen-detected, all women who attend specialised breast units invariably undergo some form of imaging, mostly mammography or ultra- sound. Emphasis on screen-detected lesions also highlights the heteroge- neous array of benign diseases in this age group, which in the future may create signifi cant breast disease workloads as longevity becomes the norm in the developed world. The pathological discussions will also include possible aetiological fac- tors and the pathogenesis of the disease processes. Most importantly, where applicable, the associated risk factors of individual conditions will be dis- cussed based on previously published data. The assessment of the potential risk of progression to malignancy is increasingly playing an important part in the management of patients with benign breast disease. However, the discus- sion of risk factors related to benign lesions is not intended to alarm the reader, because the risk of progression to malignancy in most benign lesions is very small. In addition, due to the complicated nature of the studies required to determine the risk of subsequent malignancy, the majority of the risk vii viii Preface I assessment is relative rather than absolute. As illustrated in the different chapters, with the exception of lesions such as atypical ductal hyperplasia, there is no consensus among investigators as to the level of risk associated with most benign lesions. The author therefore gathered both the supporting and the contradicting evidence on risk factors on individual benign lesions to give readers the opportunity to make up their own minds when making a clinical decision. The clinician should not apply these risk factors to patients without taking into account other parameters such as family history, previous history of cancer, menopausal status or use of hormonal therapy. The radiological features of benign diseases using different modalities such as mammography, ultrasonography and magnetic resonance will also be discussed. Detailed radiological techniques and routine interpretation of mammograms are extensively covered in appropriate textbooks, some of which have been included in the references in the appropriate chapters. Likewise, detailed histological techniques are not part of this book. The book should be useful to breast radiologists, surgeons, pathologists and other health workers who look after women with breast disease in their practices. Post- graduate students should fi nd this a quick reference book. Guernsey, UK Catherine N. Chinyama August 2003 Prefa ce II Since the publication of the fi rst edition of this book in 2004, there have been a lot of advances in radiology, pathology and molecular pathology of both benign and malignant breast diseases. There are very few books on benign breast disease, which is a gap that needs to be fi lled, because understanding of the biological behaviour of benign breast lesions will assist the clinician and the patient to assess the risk of malignancy and formulate a follow-up strategy or take appropriate preventative measures. This book has therefore attempted to evaluate the radiological and pathological features of common benign lesions and the associated risk of subsequent breast cancer and, where pos- sible, included the management of these lesions. Since the fi rst edition, there has been improved understanding of the pathology of columnar cell lesions and mucocoele-like lesions, and these chapters are much longer than in the fi rst edition. To aid better understanding of benign breast lesions, a chapter on normal breast has been included. Other new chapters include: an overview of benign breast lesions (Chap. 2 ), infl ammatory lesions (Chap. 6 ) and male breast lesions (Chap. 1 5 ). Phyllodes tumour has been included in the chapter on fi broepithelial lesions (Chap. 1 0 ) as the lesion shares clinical, radiologi- cal, pathological and genetic features with the fi broadenoma. The statistics involved in risk assessment are complex, but statistics are also becoming rou- tine in patient management. To this end, the author has expanded the chapter on risk assessment to include some defi nitions. This chapter also includes the different models used in risk assessment of breast cancer which will no doubt become routine as part of patients’ personalised medicine. The sec- ond edition also includes more radiological and pathological illustrations to refl ect the heterogeneous nature of the benign lesions. Genetic assessment is becoming part of patient management for both malignant and benign lesions. Where applicable, genetic assessment is included as part of risk assessment with regards to whether a lesion is clonal and, therefore neoplastic, or poly- clonal and hyperplastic. The previous edition concentrated mostly on screen- detected benign lesions, and this has been rectifi ed by discussing common symptomatic breast lesions, some of which have no associated risk to breast cancer. As multidisciplinary team management of patients is now the norm rather than the exception, this book will be valuable to doctors, nurses and other allied health professionals who look after patients with breast diseases in a multi-professional environment. St. Martin’s Guernsey, UK Catherine N. Chinyama ix
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