Diagnostic breast imaging: mammography, sonography, magnetic resonance imaging, and interventional procedures

496 Pages·2001·15.32 MB·English

by  D. David

I
Diagnostic Breast Imaging
2nd edition
II
III
Diagnostic Breast Imaging
Mammography, Sonography, Magnetic Resonance Imaging,
and Interventional Procedures
Second edition, enlarged and revised
Sylvia H. Heywang-Köbrunner, M.D.
AssociateProfessorandSubstituteDirector
DepartmentofDiagnosticRadiology
MartinLutherUniversityHalle-Wittenberg
Halle,Germany
D. David Dershaw, M.D.
Director,BreastImagingSection
DepartmentofRadiology
MemorialSloan-KetteringCancerCenter
NewYork,NYUSA
Ingrid Schreer, M.D.
AssistantProfessor
BreastCenter
UniversityHospital
Kiel,Germany
In collaboration with Professor Roland Bässler, M.D.
843 illustrations
Thieme
Stuttgart · New York 2001
IV
LibraryofCongressCataloging-in-PublicationData
ImportantNote:Medicineisanever-changing
Heywang-Köbrunner,SylviaH.,1956- science undergoing continual development.
[Bildgebendemammadiagnostik.English] Researchandclinicalexperiencearecontinu-
Diagnostic breast imaging : mammography, ally expanding our knowledge, in particular
sonography,magneticresonanceimaging,andinter- ourknowledgeofpropertreatmentanddrug
ventional procedures / Sylvia Heywang-Köbrunner, therapy. Insofar as this book mentions any
Ingrid Schreer, D. David Dershaw ; in collaboration dosage or application, readers may rest as-
withRolandBässler;translatedbyPeterF.Winter.— suredthattheauthors,editors,andpublishers
2nded.,enlargedandrev. have made every effort to ensure that such
p.;cm. referencesareinaccordancewiththestateof
Includesbibliographicalreferencesandindex. knowledgeatthetimeofproductionofthebook.
ISBN3131028920—ISBN1-58890-033-9 Nevertheless,thisdoesnotinvolve,imply,or
1.Breast—Imaging.2.Breast—Diseases—Diagnosis. expressanyguaranteeorresponsibilityonthe
I.Schreer,Ingrid.II.Dershaw,D.David.III.Title. partofthepublishersinrespecttoanydosage
[DNLM:1.Breast—pathology.2.BreastDiseases— instructionsandformsofapplicationstatedin
diagnosis. 3. Biopsy—methods. 4. Magnetic Reso- thebook.Everyuserisrequestedtoexamine
nance Imaging. 5. Mammography. 6. Ultrasonog- carefully the manufacturer’s leaflets accom-
raphy,Mammary.WP815H622b2000a] panyingeachdrugandtocheck,ifnecessaryin
RG493.5D52H49I32000 consultation with a physician or specialist,
618.1’90754—dc21 00-048876 whether the dosage schedules mentioned
thereinorthecontraindicationsstatedbythe
Collaborator: manufacturer differ from the statements
RolandBässler,M.D. madeinthepresentbook.Suchexaminationis
Professor,InstituteofPathology particularly important with drugs that are
MunicipalClinics eitherrarelyusedorhavebeennewlyreleased
Fulda,Germany on the market. Every dosage schedule or
everyformofapplicationusedisentirelyat
1stGermanedition1996
the user’s own risk and responsibility. The
1stEnglishedition1997
authors and publishers request every user to
Thisbookisanenlargedandrevisedneweditionof report to the publishers any discrepancies or
the authorized translation of the German edition, inaccuraciesnoticed.
published and copyrighted 1996 by Georg Thieme
Verlag,Stuttgart,Germany.
Title of the German edition: Bildgebende Mamma-
diagnostik: Untersuchungstechnik, Befundmuster
und Differentialdiagnostik in Mammographie,
SonographieundKernspintomographie
FirsteditiontranslatedbyPeterF.Winter,M.D.
©2001GeorgThiemeVerlag Someoftheproductnames,patents,andregistered
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ThiemeNewYork,333SeventhAvenue, trademarks or proprietary names even though
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thetext.Therefore,theappearanceofanamewith-
TypesettingbyprimustypeRobertHurlerGmbH outdesignationasproprietaryisnottobeconstrued
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PrintedinGermanybyDruckhausGötz, Thisbook,includingallpartsthereof,islegallypro-
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V
Preface
Theauthorspresentasecondeditionofthisbook, mography,ultrasound,MRI,andpercutaneousbi-
encouragedbythesuccessofthefirstedition.The opsy techniques has been included, and its pre-
secondeditionbecamenecessaryduetothetech- sent and future impact on diagnostic strategies
nologicprogress,increasingclinicaldata,aswellas areconsidered.Acriticalanalysisofnewmodali-
evolving,andnewclinicalandimagingstrategies. tiesunderinvestigationhasbeenadded.
Duringthelastyearsdatahascontinuedtoac- Basedonbothtechnologicprogressinmammog-
cumulate on the value of screening mammogra- raphy,ultrasound,MRI,andpercutaneousbiopsy
phyforreductionofbreastcancermortalityinthe and based on evidence from increasing study-
50−70-year age group. Furthermore, increasing proven data, standards and strategies of workup
proof now exists that similar results can also be undergo continuous evolution and adaptation.
achievedbyscreeningwomenaged40−49.Simul- The authors have presented algorithms for
taneously, other imaging modalities as well as patientmanagementbasedonthisnewmaterial.
various methods for percutaneous biopsy have Thesealgorithmstakeintoaccounttheconstantly
beenfurtherdevelopedandimproved.Thesein- increasing knowledge in this field, and they re-
creasinglysupplementmammographyincasesof flect state-of-the-art technology and clinical
diagnosticdifficultiesandintheassessmentand knowledgeinmid-2000.
management of women with breast disease. In Asinthefirstedition,theauthorshavereviewed
addition to standard two-view mammography the clinical, histopathologic, and imaging issues
andclinicalexamination,specialmammographic ofbreastdiseasetogether,inordertoprovidethe
views and sonography are an important part of necessary background for a sensible approach.
theimagingworkupofthesewomen.Forselected Thebookisnotdesignedtoreplaceinterdiscipli-
indications MR imaging increasingly proves to narywork.Rather,itishopeditwillcreateanun-
provide valuable additional information. Percu- derstandingofthevalueofcloseinterdisciplinary
taneous biopsy techniques under imaging cooperation, which is needed to achieve an op-
guidance have become an indispensable tool for timum diagnosis and treatment for the patient
minimallyinvasivediagnosisofimagingdetected withbreastdisease.Forthoseinvolvedinbreast
abnormalities. imaging this text presents findings associated
Inthissecondedition,theauthorshaveagainat- withbreastdiseasesandthedifferentialdiagnosis
tempted to present to the reader a cogent ap- foreachofthese.Theauthorsalsohavesuggested
proachtoimagingofthebreast,updatingthein- algorithmsfortheworkupofavarietyofclinical
formationavailableinthefirstedition.Again,the and imaging dilemmas. These chapters are de-
valueofimagingisanalyzedforboththesympto- signedtoassistintheworkupofthesymptomatic
maticpatientandtheasymptomaticwoman.The womenandtheinterpretationofabnormalimag-
latest results of breast cancer screening (includ- ingstudies.
ing younger age groups and latest discussions This text is also designed to review for non-
concerning the overall value) and the value of radiologist physicians the role of breast-imaging
otherimagingtechniquesinthisclinicalcontext technologiesintheworkupoftheirpatientsand
are reviewed. New information concerning the concepts involved in the interpretation of
geneticandotherriskfactorsareincludedtopro- thesestudies.Additonally,theauthorsalsohope
videsufficientbackgroundforproperapplication thatthisworkwillbeusefultotechnologistswho
and interpretation of imaging studies in these wish to add depth to their understanding of the
patients.Thelatesttechnologicprogressinmam- imagestheycreate.
VI Preface
Finallyitshouldbepointedoutthatthisworkhas women affected by this disease and those who
grown out of an international collaboration. Al- sharetheirlivesiswithoutborders.Wehaveat-
thoughthephilosophyofwhichtechnologiesare tempted to present a rational approach to the
bestusedinwhichsettingscanvaryfromnation early diagnosis of this disease for women of all
tonation,aswellasfromofficetooffice,thefear nations.
of breast cancer and its impact on individual
Acknowledgements
The production of this book represents not only expressherdeepgratitudetoDeutscheKrebshilfe
the time and effort of the authors whose names (GermanCancerFoundation)forcontinuoussup-
appearonthecover,butmultipleotherindividu- port of both education and research associated
als.Wewouldallliketothankthetechnologists withnumerousprojects.
withwhomweworkonadailybasisfortheirtire- D.DavidDershawwouldliketoacknowledge
lesseffortsandconstantcompassioninproducing the constant support, intellectual stimulation,
theimagesthatappearonthesepages.Wewould andforbearanceofhiscolleaguesinbreastimag-
alsoliketoexpressourappreciationtoCliffBerg- ingatMemorialSloan-KetteringCancerCenterin
manatThiemewhohelpeduscreatethefirstedi- NewYork:Drs.AndreaAbramson,LindaLaTrenta,
tionofthistextandguidedusthroughthesecond LauraLiberman,andElizabethMorris.Theircon-
edition.Inaddition,eachofuswouldliketothank stant love, humor, devotion to quality, and good
special individuals who have made this project taste make each day at work special; without
possible. them,itneverwouldhavehappened.Andtothe
Sylvia H. Heywang-Köbrunner would like to ex- RadiologyDepartmentatMemorialthathassup-
presshersincerethankstothosecolleagueswho portedtheacademicendeavorsoftheBreastIm-
have accompanied her for many years and who agingSectionformanyyears,thanksagain.Toour
have made high-quality work and research manyfellows,whoworksohard,asksomanydif-
possible by their constant support, enthusiasm, ficult questions and keep us thinking, you are
andtheircareforthepatient:Dr.RainerBeck,Dr. deeply appreciated, fondly remembered, and
Thomas Hilbertz, Dr. Petra Viehweg, Dr. Anke often missed. Thanks to Beckie, Bruce, Brewster,
Heinigandnumerousotheryoungcolleaguesand John, Alan, and Andrea, who have made it
students, who joined us in our efforts and sup- possible to get through it all. And for Ryan, a
ported our work. She is very greatful for the specialthanks.
unique cooperation with her clinical partners IngridSchreerwouldliketoexpresshergratitude
from gynecology, breast surgery, and pathology: for the excellent collaboration within the multi-
Prof. Dr. W. Permanetter, Prof. Dr. H. Hepp, Prof. disciplinary team of physicians, technologists,
Dr.F.-W.Rath,PDDr.J.Buchmann,Dr.D.Lampe, and other coworkers at the University of Kiel.
and Prof. Dr. H. Kölbl. Deep appreciation goes to Specialthanksgotothebreastimagingteam,in
Prof.Dr.R.Bässler,whoreviewedcrucialpartsof particular to Ms. M. Dickhaut and Ms. A. Große,
thisbook.Aspecialnoteofgratitudeisaddressed who continuously supported the daily clinical
to the technologists at the University of Halle, andscientificworkwithalltheireffortandwith
particularlyMs.KlemmeandMs.Theuerkorn,for empathywiththepatients.Thisworkwouldnot
whomqualityandpatientcarehavealwaysbeen havebeenpossiblewithoutthem.Deepapprecia-
themostimportantgoalandwhohaveconstantly tionsgotoProf.H.-J.Frischbier,whoseworkand
supported research and teaching at our institu- support constituted an essential basis for this
tion.Aspecialnoteofgratitudemustbeaccorded book.
toMs.A.Fulbrecht,whotypedmajorpartsofthe
manuscript. Sincere thanks go to Prof. Dr. Dr. J. SylviaH.Heywang-Köbrunner,M.D.
Lissner and Prof. Dr. R. P. Spielmann, who sup- D.DavidDershaw,M.D.
portedthiswork.Finallytheauthorwouldliketo IngridSchreer,M.D.
VII
Contents
I Methods
1. Patient History and Communication with the Patient 2
Scheduling ......................... 2 PatientHistory ..................... 3
PatientInformation ................ 2 References ......................... 7
2. Clinical Findings 9
VisualInspection ......................... 9 References ......................... 13
Palpation ................................ 10
3. Mammography 14
Purpose,Accuracy,Possibilities,andLimita- PositioningofBreasts
tions..................................... 14 withImplants ...................... 56
Indications......................... 14 SpecimenRadiography ............. 59
Accuracy........................... 14 QualityFactors ........................ 60
Screening .......................... 15 HardwareFactorsthatInfluence
ProblemSolving.................... 15 ImageQuality ...................... 60
MammographicTechnique............. 16 InfluenceoftheScreen–FilmSystem
ComponentsoftheMammographicIm- andFilmProcessingonImage
agingTechnique....................... 17 Quality ............................ 62
SpecificRequirementsandSolutions ... 26 QualityAssurance
ImageSharpness ................... 26 inMammography .................. 63
Contrast ........................... 27 ReportingandDocumentation
Noise .............................. 36 Findings .............................. 65
RadiationDose ..................... 36 ClinicalFindings.................... 65
PositioningandCompression .......... 39 MammographyReport.............. 65
Compression ....................... 39 DigitalMammography .................... 71
PositioningforStandardViews...... 41 Galactography............................ 74
PositioningforAdditionalViews .... 45 Appendix:SonographicImagingof
FilmLabelling ......................... 50 LactiferousDucts ................... 78
SpotCompressionandMagnification Pneumocystography ...................... 81
Technique ......................... 52 References ......................... 83
VIII Contents
4. Sonography 87
Purpose,Accuracy,Possibilities,andLimita- ImageQuality ...................... 89
tions..................................... 87 ExaminationTechnique ................... 92
DiagnosingCysts ................... 87 Time-gainCompensation ........... 92
DifferentiatingSolidLesions ........ 87 Focusing ........................... 93
DiagnosingCarcinoma .............. 87 ExaminationTechnique............. 93
YoungerWomen ................... 88 InterpretingSonographicFindings ......... 96
ScreeningwithSonography ......... 88 NormalSonographicFindings ....... 96
EquipmentRequirements ................. 88 FocalSonographicLesions .......... 97
Transducer......................... 88 References ......................... 102
5. Magnetic Resonance Imaging (MRI) 103
Purpose,Accuracy,Possibilities,andLimita- PlanningtheExamination .......... 108
tions..................................... 103 ExaminationProcedure ............. 109
Accuracy........................... 103 InterpretationCriteriaand
Indications......................... 104 DocumentationofFindings ......... 109
TechnicalRequirements .................. 106 InterpretationCriteria .............. 110
ExaminationProcedure ................... 108 References ......................... 125
6. Breast Imaging Techniques under Investigation 128
Scintimammography ............... 128 OtherMethods ..................... 129
PositronEmissionTomography ..... 129 References ......................... 130
7. Percutaneous Biopsy 132
Purpose............................ 132 FineNeedleAspiration ............. 136
Definitions ......................... 132 CoreNeedleBiopsy................. 137
Accuracy........................... 133 Vacuum-SuctionBiopsy ............ 137
PossibilitiesandLimitations ........ 134 Ultrasound-GuidedBiopsy .......... 140
Contraindications .................. 135 StereotacticBiopsy ................. 141
Complications...................... 135 MR-GuidedPercutaneousBiopsy .... 146
PatientInformation,PatientPrepara- References ......................... 150
tion,andPostbiopsyCare ........... 136
TechniquesforBiopsyandBiopsy
Guidance ................................ 136
8. Preoperative Localization 152
Purpose,Definition,Indications,andSide MR-GuidedLocalization ............ 157
Effects ................................... 152 GalactographicallyGuidedLocaliza-
MethodsandTechnique .................. 153 tion ............................... 158
MammographicallyGuidedLocaliza- LocalizationMaterials ................. 158
tionTechniques .................... 153 ProblemsandTheirSolutions .......... 159
Ultrasound-GuidedLocalization ..... 155 References ......................... 160
Contents IX
II Appearance
9. The Normal Breast 162
Anatomy........................... 162 Macromastia ............................. 173
TheAdolescentFemaleBreast ............. 163 ClinicalExamination................ 173
Histology .......................... 163 Mammography..................... 173
ClinicalExamination................ 163 Sonography ........................ 173
Mammography..................... 163 Mammography..................... 173
TheMatureFemaleBreast ................ 163 SonographyandMagneticResonance
Histology .......................... 163 Imaging ........................... 173
Sonography ........................ 163 InvertedNipple .......................... 174
ClinicalExamination................ 163 ClinicalExamination................ 174
Mammography..................... 165 Mammography..................... 174
Sonography ........................ 166 Sonography ........................ 174
MagneticResonanceImaging ....... 168 MagneticResonanceImaging ....... 174
Involution................................ 170 PregnancyandLactation .................. 175
Histology .......................... 170 Histology .......................... 175
ClinicalExamination................ 170 ClinicalExamination................ 175
Mammography..................... 170 Mammography..................... 175
Sonography ........................ 170 BreastResponsewithHormoneReplace-
MagneticResonanceImaging ....... 170 mentTherapy ............................ 177
Abnormalities ............................ 171 Sonography ........................ 177
Asymmetry .............................. 171 MagneticResonanceImaging ....... 177
ClinicalExamination................ 171 Mammography..................... 177
Mammography..................... 171 Sonography ........................ 180
AccessoryBreastTissue(Polymastia) ...... 173 MagneticResonanceImaging ....... 180
ClinicalExamination................ 173 PercutaneousBiopsy ............... 180
References ......................... 180
10. Benign Breast Disorders 181
Pathogenesis ....................... 181 Mammography..................... 184
Incidence .......................... 181 Sonography ........................ 191
Histopathology..................... 181 MagneticResonanceImaging ....... 192
ClinicalFindings.................... 183 PercutaneousBiopsy ............... 195
DiagnosticStrategyandObjectives .. 183 References ......................... 196
11. Cysts 197
Histology .......................... 197 AspirationoftheCyst .............. 201
MedicalHistoryandClinicalFind- Pneumocystography ................ 202
ings ............................... 197 Mammography..................... 202
BreastExamination................. 197 MagneticResonanceImaging ....... 202
ObjectivesofDiagnosticStudies..... 198 Appendix:GalactocelesandOilCysts ...... 205
DiagnosticStrategy................. 198 References ......................... 208
Sonography ........................ 198