Breast Imaging: The Requisites

513 Pages·2016·27.88 MB·English

by  Debra M. Ikeda

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THE REQUISITES
Breast Imaging
The Requisites Series
SERIES EDITOR TITLES IN THE SERIES
James H. Thrall, MD Breast Imaging
Radiologist-in-Chief Emeritus Cardiac Imaging
Massachusetts General Hospital Emergency Imaging
Distinguished Juan M. Taveras Professor of Radiology Gastrointestinal Imaging
Harvard Medical School Genitourinary Imaging
Boston, Massachusetts Musculoskeletal Imaging
Neuroradiology Imaging
Nuclear Medicine
Pediatric Imaging
Thoracic Imaging
Ultrasound
Vascular and Interventional Imaging
THE REQUISITES
Breast Imaging
THIRD EDITION
Debra M. Ikeda, MD, FACR, FSBI
Professor
Department of Radiology
Stanford University School of Medicine
Stanford, California
Kanae K. Miyake, MD, PhD
Program-Specific Assistant Professor
Department of Diagnostic Imaging and Nuclear Medicine
Kyoto University Graduate School of Medicine
Kyoto, Japan
Visiting Assistant Professor
Department of Radiology
Stanford University School of Medicine
Stanford, California
3251 Riverport Lane
St. Louis, Missouri 63043
THE REQUISITES: BREAST IMAGING, THIRD EDITION ISBN: 978-0-323-32904-0
Copyright © 2017 by Elsevier Inc.
Previous editions copyrighted 2011 and 2004
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluat-
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Library of Congress Cataloging-in-Publication Data
Names: Ikeda, Debra M., author. | Miyake, Kanae K., author.
Title: Breast imaging / Debra M. Ikeda, Kanae K. Miyake.
Other titles: Requisites series.
Description: Third edition. | St. Louis, Missouri : Elsevier, [2017] |
Series: Requisites | Includes bibliographical references and index.
Identifiers: LCCN 2016032302 | ISBN 9780323329040 (hardcover : alk. paper)
Subjects: | MESH: Mammography | Breast Diseases--diagnosis | Ultrasonography,
Mammary | Magnetic Resonance Imaging--methods
Classification: LCC RG493.5.R33 | NLM WP 815 | DDC 618.1/907572--dc23 LC record available at
https://lccn.loc.gov/2016032302
Executive Content Strategist: Robin Carter
Content Development Specialist: Angie Breckon
Publishing Services Manager: Julie Eddy
Book Production Specialist: Clay S. Broeker
Design Direction: Amy Buxton
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
For my mother, Dorothy Yoshie Kishi Ikeda
Pearl City, Hawaii
and
For my father, Otto Masaru Ikeda, and brother
Clyde Seiji Ikeda
Puowaina (Punchbowl), Honolulu, Hawaii
Debra M. Ikeda
For my mother, Chikako Miyake
Gifu, Japan
and
For my father, Akihide Miyake
Tokiwacho, Kyoto, Japan
Kanae K. Miyake
Contributors
Bruce L. Daniel, MD Ellen B. Mendelson, MD, FACR, FSBI, FSRU
Professor of Radiology Lee F. Rogers Professor of Medical Education in Radiology
Stanford University School of Medicine Professor of Radiology
Stanford, California Department of Radiology
Feinberg School of Medicine, Northwestern University
Frederick M. Dirbas, MD Chicago, Illinois
Associate Professor of Surgery
Stanford University School of Medicine Kanae K. Miyake, MD, PhD
Leader, Breast Disease Management Group Program-Specific Assistant Professor
Stanford Cancer Center Diagnostic Imaging and Nuclear Medicine
Stanford, California Kyoto University Graduate School of Medicine
Kyoto, Japan
Dipti Gupta, MD Visiting Assistant Professor
Assistant Professor Department of Radiology
Section of Breast Imaging Stanford University School of Medicine
Northwestern Memorial Hospital Stanford, California
Chicago, Illinois
Camila Mosci, MD, MSc
R. Edward Hendrick, PhD, FACR, FSBI, FAAPM, FISMRM Professor of Nuclear Medicine
Clinical Professor of Radiology Department of Radiology
University of Colorado-Denver School of Medicine University of Campinas
Aurora, Colorado Campinas, Sao Paulo, Brazil
Kathleen C. Horst, MD Dung H. Nguyen, MD, PharmD
Assistant Professor Clinical Assistant Professor
Department of Radiation Oncology Stanford University
Stanford University School of Medicine Stanford, California
Stanford, California Director of Breast Reconstruction
Stanford Cancer Center
Debra M. Ikeda, MD, FACR, FSBI Palo Alto, California
Professor
Department of Radiology Andrew Quon, MD
Stanford University School of Medicine Medical Director, Clinical PET-CT
Stanford, California Associate Professor of Radiology
Stanford University School of Medicine
Stanford, California
vi
Foreword
The first two editions of Breast Imaging: The Requisites genotype-related risks. Likewise, strategies incorporating
were both outstanding texts and captured the philoso- nuclear medicine, ultrasound, and MRI methods have been
phy of the Requisites in Radiology series by presenting developed to help better detect disease in women with
complex material in a concise, logical, and straightforward dense breast tissue.
way, making the material very accessible to the reader. Drs. High-quality images are a fundamental basis for success-
Ikeda and Miyake and their contributors have again suc- ful radiology practice. Presentation of high-quality images is
ceeded in achieving these attributes for the third edition even more important in textbooks in order to provide the
of their book. Important new material has been added, and reader with clear, easily comprehended examples of image
material on all enduring methods has been updated. findings. Drs. Ikeda and Miyake and their contributors have
In light of the trend toward standardized reporting in achieved a high standard in this regard. Readers will again
radiology, it is noteworthy that breast imaging has been find that this edition of Breast Imaging: The Requisites is
an exemplar within the specialty for the use of standard- generously illustrated with very high-quality material.
ized reporting through the use of BI-RADS®. Indeed, un- While the technology and scientific understanding of
derstanding the use of this reporting system is crucial to breast imaging continue to advance, the special relation-
successful clinical practice in breast imaging. To this end, ship of breast imaging specialists and their patients has not
Drs. Ikeda and Miyake have systematically incorporated changed. Breast imaging radiologists have a special respon-
the revised BI-RADS® 2013 system that encompasses ul- sibility as stewards of patient care in going from screen-
trasound and MRI reporting as well as mammography, and ing to diagnosis, to assessment of surgical specimens, to
they explain how to use the BI-RADS® 2013 lexicon cor- clinical staging, and finally to assessment of therapeutic
rectly. Readers will find this material of daily practical use. outcome and long-term follow-up. The intimate relation-
Screening and diagnostic applications of x-ray mammog- ship between radiologists and their patients with breast
raphy remain the most commonly performed procedures disease is unique in radiology practice. As in the previous
in breast imaging, but the technology for performing these editions of Breast Imaging: The Requisites, Drs. Ikeda and
studies has changed dramatically over the last decade, with Miyake have captured the importance of this relationship
widespread use of digital imaging and increasing use of and especially the philosophy that the fundamental goal is
tomosynthesis. These advances in technology are compre- to save women’s lives.
hensively described in the third edition of Breast Imaging: The Requisites in Radiology series is well into its third
The Requisites. Many positive consequences related to the decade and is now an old friend to a large number of ra-
use of digital mammography and tomosynthesis have been diologists around the world. The intent of the series has
more firmly established since the previous edition, such always been to provide residents, fellows, and clinical
as improved cancer detection and reduced callback rates. practitioners with reliable, factual material, uncluttered
Beyond x-ray–based mammography, no area of special- with conjecture or speculation, that can serve as a durable
ization in radiology has seen more expansion of scope or basis for daily practice. As series editor, I have always asked
complexity than breast imaging. The specialty now en- writers to include what they use in their own practices
compasses the use of all medical imaging methods—x-ray, and what they teach their own trainees and to not include
ultrasound, MRI, nuclear medicine—and addresses a spec- extraneous material just for the sake of “completeness.”
trum of applications that includes screening, diagnosis, Reference books are also valuable but serve a different
surveillance, interventions, and assessment of therapeutic purpose.
efficacy. Functional and molecular information is now in- I would like to congratulate Drs. Ikeda and Miyake for
corporated into the practice of breast imaging. Separate sustaining the goals of the Requisites series and for pro-
chapters of Breast Imaging: The Requisites are devoted ducing another outstanding book. Readers will benefit
to each of these topics. The chapters are laid out in a logi- from the authors’ knowledge and also from their experi-
cal fashion, with a succinct summary statement of key ele- ence and wisdom in one of the most challenging areas of
ments at the end. medical practice.
New material in the third edition incorporates substan-
tial advances in our understanding of the challenges of James H. Thrall, MD
diagnosing breast cancer and therewith development of Radiologist-in-Chief Emeritus
optimal strategies for employing different imaging meth- Massachusetts General Hospital
ods. For example, strategies for enhanced surveillance us- Distinguished Taveras Professor of Radiology
ing ultrasound and MRI have been informed by advances Harvard Medical School
in our understanding of the genetics of breast cancer and Boston, Massachusetts
vii
Preface
The specialty of breast imaging is a uniquely challenging and per- Two days before Christmas in 1986, in my junior year as a
sonal combination of imaging, biopsy procedures, clinical corre- resident, my 62-year-old mother’s mammogram showed a 7-mm
lation, advances in technology, and compassion. A breast cancer suspicious spiculated nonpalpable breast mass. The mass was
diagnosis is intensely personal and potentially devastating for the detected because the University of Michigan had hired Visiting
patient. The radiologist’s job is to detect and diagnose the can- Professor Dr. Ingvar Andersson from Malmo, Sweden (principal
cer and gently support the patient through discovery, diagnosis, investigator of the randomized, controlled, population-based
treatment, and follow-up. The radiologist’s role has changed from Malmo Mammographic Screening Project), who updated our
simply identifying cancers to being deeply involved in diagnosis, equipment, started a QA program, and taught faculty/trainees
biopsy, and follow-up. Instead of sitting alone in a dark room, the state-of-the-art breast imaging interpretation. Because of him, my
radiologist is truly part of a team of oncologic surgeons, patholo- mother underwent a brand-new diagnostic technique brought
gists, radiation oncologists, medical oncologists, plastic surgeons, from Sweden: fine-needle aspiration under x-ray guidance using a
geneticists, and, most importantly, the patient. grid coordinate plate. The aspirate showed cancer. We were dev-
This is a very simple book. Its purpose is to help the first-year astated. My mom had a second opinion for surgery on Christmas
resident understand why the mammogram, the ultrasound, and Eve and underwent mastectomy 2 days after Christmas. On New
the MRI look the way they do in benign disease or in cancer. Year’s Eve, we got the good news that it was a very small invasive
The other purpose is to help senior residents/fellows pass their tumor, that there were negative axillary lymph nodes, and that
boards. With careful scrutiny of each chapter, residents will know she had a good prognosis.
clinical scenarios in which cancers occur; develop a systematic Naturally, I wanted to learn everything about breast imaging
method of analyzing images; be able to generate a differential because of my experience of what happens within families when
diagnoses for masses, calcifications, and enhancement; and know a loved one is diagnosed with breast cancer. I knew that diagno-
how manage patients. sis and treatment of early-stage breast cancers can result in a long,
Even though the book is simple, the pictures and tools in the healthy life for the woman. I knew that we, as radiologists, could
book can be adapted to your general clinical practice. Thus, when train to find and diagnose early breast cancer, profoundly affect-
you come upon a tough case out in the “real world,” look to the ing women and their families for the better. So I learned breast
skills that you learned in this book to solve problems. Use all imaging from excellent teachers. Dr. Miyake and I want you to
the tricks you learned on each tough case, because there will learn breast imaging, find the little cancer like my mother’s tu-
be tough cases. Adversity is inevitable. If you welcome adversity mor, and save her life again.
as your personal challenge and opportunity, and if you use com- My mom is now 92 years old and living in Hawaii. Remember
mon sense, you will most certainly succeed. Remember, the goal our story. I want everyone who reads this book to have the op-
of imaging is for the good of the patient—to diagnose and treat portunity to perceive and diagnose small cancers, intervene, and
breast cancer so that the patient will live. Therefore, with each have this outcome. When this outcome is not possible, I want
challenging case, view the adversity of the difficult diagnosis as everyone who reads this book to use their knowledge to help
your responsibility, your challenge, and your opportunity. Keep their patient through her journey. Someday we may not need this
using the tools in this book until you overcome your problem. book because there will be further advances in science. Until that
As Bruce Daniel told me when I was flailing around in the most happy day comes, we ask those who read this book to use your
difficult of MRI-guided procedures, within the realm of common knowledge to help women.
sense, “Never give up!”
Debra M. Ikeda, MD, FACR, FSBI
viii