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Breast Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
“Alternative” medical treatments are not always safe or benign. The thermographer may encounter patients who have self-treated palpable breast masses with escharotic salves, on the theory that chemically burning the overlying skin will “dissolve” the underlying mass. These salves often contain bloodroot (Sanguinaria canadensis) or other topically toxic ingredients. If used over a period of time, escharotics kill the dermis, leaving a full-thickness denuded wound that appears very warm to thermal imaging (Figure 9.30). This inflamed wound obscures any thermal findings from the underlying mass, making breast thermography useless until the area heals completely. Ultrasonography, X-ray mammography, or breast MRI may be required to determine the nature of any masses.
Preoperative radiological assessment
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
In the setting of newly diagnosed breast cancer, MRI has been shown to be more accurate in determining true tumor size and disease extent when compared to conventional mammography and ultrasound (Figure 7.4).32 In a meta-analysis of 19 studies that included 2610 patients, preoperative MRI depicted additional sites of disease which were occult using other imaging techniques in 16% of patients.33 In addition, staging-oriented bilateral breast MRI has demonstrated the presence of a synchronous tumor site in the contralateral breast in 3%–5%.34 Despite the detection of additional disease, several retrospective studies have concluded that preoperative breast MRI does not lead to reductions in: (1) risk of local or distant recurrence, (2) re-operation rates, or (3) rates of conversion from conservation therapy to mastectomy.35,36 Furthermore, Yi and colleagues compared rates of breast cancer disease-free survival in patients with newly diagnosed breast cancer with and without preoperative MRI imaging and found no reduction in risk of local-regional nor distant recurrence in the two patient populations. Nonetheless, a reduced risk of contralateral breast cancer recurrence was observed in patients receiving preoperative MRI.37
Breast imaging
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
MRI of the breast should not be used as a stand-alone diagnostic tool but may be useful problem-solving adjunct to the triple assessment process. Breast MRI can, however, detect lesions not seen on conventional imaging as it has inherent high sensitivity although it does suffer from decreased specificity. In the young dense breast, the sensitivity of mammography for breast cancer is reduced and investigation with MRI may be indicated. Breast biopsy under MRI guidance is becoming more widely available and is used when a lesion is only detectable by MRI.
Patient-derived breast model repository, a tool for hyperthermia treatment planning and applicator design
Published in International Journal of Hyperthermia, 2022
Ioannis Androulakis, Kemal Sumser, Melanie N. D. Machielse, Linetta Koppert, Agnes Jager, Remi Nout, Martine Franckena, Gerard C. van Rhoon, Sergio Curto
An additional limitation of previous studies is that the anatomical variations of the breast and pathological variations of the breast cancers are not widely covered. Women with a higher relative amount of fibroglandular tissue are linked with a higher risk of developing breast cancer [20]. But the amount of fibroglandular tissue in the breast can vary immensely, and the breast is usually classified into four categories (I – almost entirely fat, II – scattered fibroglandular tissue, III – heterogeneous fibroglandular tissue, IV – extreme fibroglandular tissue) [21], based on mammographic imaging. In breast MRI, there is, in general, no consensus on how breast density should be quantified [22]. However, the same breast composition categories applied in mammography are commonly used. In terms of tumor characteristics, the vast majority (62%) of breast tumors are diagnosed in the upper outer quadrant [23]. But tumors in the upper outer quadrant are also linked with a more favorable survival advantage than other tumor locations [24]. Solid breast tumors are staged based on their longest spatial dimension. While a higher tumor stage is correlated with less favorable survival, also the tumor shape can vary vastly and can determine the aggressiveness of a tumor [25]. Therefore, there is a need for a repository that includes a representative variety of models.
Feasibility of Magnetic Technique for Axillary Staging after Neoadjuvant Therapy in Breast Cancer Patients
Published in Journal of Investigative Surgery, 2022
Additionally, SPIO may complicate subsequent magnetic resonance imaging (MRI) examinations [11]. An analysis of post-operative breast MRI in SentiMAG trial participants, demonstrated that void artifacts could potentially obscure important clinical findings [24]. Additional studies regarding the use of SPIO in high-risk patients in whom follow-up MRI is clinically indicated. It should be remembered that patients with hypersensitivity to iron or dextran compounds and patients with pacemakers or metal implants were not suitable for using SPIO [13]. Other limitation already identified in the literature of the Sentimag includes the need to use plastic surgical instruments. This may be a problem in obese patients especially who may require deep axillary dissection [13]. Another technical disadvantage of Sentimag procedure is the large diameter of the handheld probe, which makes it necessary to enlarge the incision to insert the probe and to identify the magnetic SN [23]. New generation devices have relatively smaller diameters to address this issue. In the literature, there is a lack of cost-effective studies comparing magnetic method with radioisotopes [21]. Specific studies are desirable in relation to a systematic cost assessment.
Locoregional therapy in breast cancer patients treated with neoadjuvant chemotherapy
Published in Expert Review of Anticancer Therapy, 2021
Sonja Murchison, Pauline Truong
Prior to initiating NAC, comprehensive evaluation of all breast and nodal disease should be performed. This includes clinical and radiologic assessment of both breasts, with biopsy of any suspicious lesions. Physical examination of the breasts with description of palpable lesions, and identification of clinically suspicious nodes is important for monitoring response during NAC. Palpable nodes can be further evaluated with ultrasound, biopsy, and clip placement, which is important for determining treatment response and ensuring adequate surgical resection following NAC. The standard imaging at initial evaluation includes mammogram and ultrasound. Breast MRI may be helpful to assess disease extent more completely, identify multifocality, and suspicious nodes, but comes with a risk of false positives [32]. For surgical planning, MRI can evaluate and monitor resectability, as features such as chest wall involvement or residual disease may be better seen with this modality.