Table Of ContentMedical Radiology · Diagnostic Imaging
Series Editors: Hans-Ulrich Kauczor · Paul M. Parizel · Wilfred C.G. Peh
Michael Fuchsjäger
Elizabeth Morris
Thomas Helbich Editors
Breast
Imaging
Diagnosis and Intervention
Medical Radiology
Diagnostic Imaging
Series Editors
Hans-Ulrich Kauczor
Paul M. Parizel
Wilfred C. G. Peh
The book series Medical Radiology - Diagnostic Imaging provides accurate and
up-to-date overviews about the latest advances in the rapidly evolving field of
diagnostic imaging and interventional radiology. Each volume is conceived as
a practical and clinically useful reference book and is developed under the
direction of an experienced editor, who is a world-renowned specialist in the
field. Book chapters are written by expert authors in the field and are richly
illustrated with high quality figures, tables and graphs. Editors and authors are
committed to provide detailed and coherent information in a readily accessible
and easy-to-understand format, directly applicable to daily practice.
Medical Radiology - Diagnostic Imaging covers all organ systems and
addresses all modern imaging techniques and image-guided treatment
modalities, as well as hot topics in management, workflow, and quality and
safety issues in radiology and imaging. The judicious choice of relevant topics,
the careful selection of expert editors and authors, and the emphasis on
providing practically useful information, contribute to the wide appeal and
ongoing success of the series. The series is indexed in Scopus.
Michael Fuchsjäger
Elizabeth Morris • Thomas Helbich
Editors
Breast Imaging
Diagnosis and Intervention
Editors
Michael Fuchsjäger Elizabeth Morris
Department of Radiology Department of Radiology
Medical University of Graz University of California, Davis (UCD)
Graz, Austria School of Medicine
Sacramento, CA
Thomas Helbich USA
Department of Biomedical Imaging and
Image-guided Therapy
Medical University of Vienna
Vienna, Austria
ISSN 0942-5373 ISSN 2197-4187 (electronic)
Medical Radiology
ISSN 2731-4677 ISSN 2731-4685 (electronic)
Diagnostic Imaging
ISBN 978-3-030-94917-4 ISBN 978-3-030-94918-1 (eBook)
https://doi.org/10.1007/978-3-030-94918-1
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To my parents Edith and Norbert, to my wife Nina and to my
children Sophie, Maximilian, Livia, Alexander, Johannes and
Laia, for their love and support; without you this wouldn’t have
been possible.
– Michael Fuchsjäger
To my children who are my greatest joy...
– EAM
To my parents, Ilse and Rudolf, who inspired me and helped me
live my dreams.
To my wife, Angelika, who supports me endlessly and makes life
rich in love.
To my children, Matthaeus Elisa, Julian Augustus, and Klara
Paulina, who make everything worthwhile.
– Thomas Helbich
Preface
The book you are about to read is important, not only because breast cancer
remains a major health problem globally—in Europe and in the USA every
year 576,000 and 264,000 women are diagnosed with breast cancer, respec-
tively—but also as it contains the most up-to-date information on breast
imaging, screening, diagnosis, intervention and therapy. Advances in screen-
ing, diagnosis and therapeutics happen at an accelerated pace. In order to
keep up we need to have an open mind, and a nimble ability to adapt rapidly,
a skill that is fortunately innate to radiologists.
Through the imaging options available for women these days, not just
mammography but also digital breast tomosynthesis, ultrasound, and breast
MRI, the radiologist could improve the rate of successful treatments within
cancer patients significantly, with an outcome not just for the lives of women
but also for their families and society in general.
By focusing on personal screening as an additional testing to the mam-
mogram, we radiologists strive to lower the risk of each woman with breast
cancer. Radiology sets new measures in this field, introducing quality stan-
dards, reporting standards and now the implementation of artificial intelli-
gence into the workflow and interpretations of mammograms. We no longer
remain hidden behind our results; we have become the face of the breast care
expert, doing biopsy procedures, discussing results and managing options
with and for our patients.
And we love being so close to our patients, being engaged in the whole
diagnostic and therapeutic journey from detection at screening through diag-
nostic imaging, image-guided biopsy, staging, minimally invasive treatment,
treatment monitoring and follow-up.
We are the gatekeepers in medicine who help start the process getting our
patients to be good or at least better in the end. As a multi-discipline matter
we spend a large amount of time talking and consulting with colleagues from
Surgery, Gynaecology, Oncology, Pathology as well as Family Medicine, to
take care of patients in the best possible way.
All of this makes Breast Imaging the probably most exciting subspecialty
and brings us even closer to our patients, involving us into the whole diagnos-
tic and therapeutic journey. We are not just doctors, we are also advisers,
carers and guides through a sometimes-difficult pathway which challenges us
to find the best outcome for each woman.
By reading this book you will come to an even better understanding of the
multiple roles of the breast imager and the numerous aspects of breast imag-
vii
viii Preface
ing from screening to minimally invasive therapy, including AI. Almost
everything you need to know on breast imaging and breast intervention can
be found in this book. All imaging techniques are brilliantly described from
intermediate to expert knowledge. Furthermore, there is a focus on breast
interventions with all guidance methods as well as image-guided minimally
invasive therapy, a step into the future. Burning topics like breast density, the
practical value of artificial intelligence or the most challenging histopatholo-
gies with high-risk lesions and DCIS are given special attention.
The highest standard, our maximum effort, the closest working together,
the best findings, all come together for the one purpose we all serve, the well-
being of the women who come to us for help. They are our focus and they are
the reason this book is in your hands, to improve the rate of successful out-
come within our breast cancer patients.
Graz, Austria Michael Fuchsjäger
Sacramento, CA, USA Elizabeth Morris
Vienna, Austria Thomas Helbich
Contents
Mammography and Digital Breast Tomosynthesis: Technique . . . . . 1
Ioannis Sechopoulos
Contrast-Enhanced Mammography . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Anand Narayan and Maxine Jochelson
Mammography Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Carin Meltzer and Per Skaane
Stereotactic Guided Breast Interventions . . . . . . . . . . . . . . . . . . . . . . . 69
Daniela Bernardi and Vincenzo Sabatino
How to Use Breast Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Boris Brkljačić, Gordana Ivanac, Michael Fuchsjäger,
and Gabriel Adelsmayr
Breast Ultrasound: Advanced Techniques . . . . . . . . . . . . . . . . . . . . . . 113
Andy Evans
Automated Breast Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Ritse M. Mann
Ultrasound-Guided Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Eva Maria Fallenberg
Breast MRI: Techniques and Indications . . . . . . . . . . . . . . . . . . . . . . . 165
Francesco Sardanelli, Luca A. Carbonaro, Simone Schiaffino,
and Rubina M. Trimboli
Abbreviated Breast MRI: Short and Sweet? . . . . . . . . . . . . . . . . . . . . 215
Michelle Zhang, Victoria L. Mango, and Elizabeth Morris
Breast MRI: Multiparametric and Advanced Techniques . . . . . . . . . 231
Maria Adele Marino, Daly Avendano, Thomas Helbich, and Katja
Pinker
MRI-Guided Breast Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Karim Rebeiz and Elizabeth Morris
Imaging the Axilla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Fleur Kilburn-Toppin
ix
x Contents
Imaging of Ductal Carcinoma In Situ (DCIS) . . . . . . . . . . . . . . . . . . . 287
Paola Clauser, Marianna Fanizza, and Pascal A. T. Baltzer
Cystic and Complex Cystic and Solid Lesions . . . . . . . . . . . . . . . . . . . 303
Panagiotis Kapetas and Thomas Helbich
High-Risk Lesions of the Breast: Diagnosis and Management . . . . . . 337
Maria Adele Marino, Katja Pinker, and Thomas Helbich
Minimal Invasive Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Gabriel Adelsmayr, Gisela Sponner, and Michael Fuchsjäger
Post-therapy Evaluation (Including Breast Implants). . . . . . . . . . . . . 375
Silvia Pérez Rodrigo and Julia Camps-Herrero
Impact and Assessment of Breast Density . . . . . . . . . . . . . . . . . . . . . . 419
Georg J. Wengert, Katja Pinker, and Thomas Helbich
Artificial Intelligence in Breast Imaging . . . . . . . . . . . . . . . . . . . . . . . . 435
Xin Wang, Nikita Moriakov, Yuan Gao, Tianyu Zhang,
Luyi Han, and Ritse M. Mann
