Diagnostic Imaging ; Breast

1345 Pages·2019·123.158 MB·English

by  Wendie A. Berg, Jessica Leung

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THIRD EDITION
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THIRD EDITION
Wendie A. Berg, MD, PhD, FACR, FSBI
Professor of Radiology
University of Pittsburgh School of Medicine
UPMC Magee-Womens Hospital
Pittsburgh, Pennsylvania
Jessica W. T. Leung, MD, FACR, FSBI
Professor of Diagnostic Radiology
Section Chief of Breast Imaging
The University of Texas MD Anderson Cancer Center
Houston, Texas
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DIAGNOSTIC IMAGING: BREAST, THIRD EDITION ISBN: 978-0-323-54812-0
Copyright © 2019 by Elsevier. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek
permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted
herein).
Notices
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds or experiments described herein.
Because of rapid advances in the medical sciences, in particular, independent verification of
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assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or
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of any methods, products, instructions, or ideas contained in the material herein.
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Dedications
We dedicate this book to the journeys in life. The pursuit of better screening, diagnosis, and less
invasive treatment for breast cancer. Our patients, from whom we are often reminded of what
truly matters. Our colleagues, who have generously shared their experience, images, and time.
The reader, whom we hope will gain a foundation on which to build. And finally, we dedicate
this and all our efforts to our families and loved ones, who have been with us
every step of our journeys.
Wendie is thankful for the tremendous progress that has been made in breast cancer diagnosis
and treatment since her aunt’s diagnosis at age 40, then death from recurrence and metastases
at age 60 in the early 1970s. Her mother Lois’s diagnosis was made in the operating room, and
she awoke with a mastectomy in 1975, then participated in the first adjuvant chemotherapy
trial and lived another 41 years disease free. Wendie’s own cancer was hidden by dense breast
tissue on tomosynthesis and diagnosed early, because she sought and obtained high-risk
screening MR and required only minimal treatment with lumpectomy and radiation. To help
other women and providers access appropriate information, she cofounded (with JoAnn Pushkin
and Cindy Henke-Sarmento) the website DenseBreast-info.org. The subsequent discovery of
a pathogenic BRCA1 variant in several members of her family has only intensified Wendie’s
motivation to educate and expand earlier genetic testing so that appropriate screening &/or
preventive surgery can be initiated and reduce late-stage disease. Improving early detection
for best friend and daughter, Monica, and future generations inspires Wendie. She is especially
grateful to husband, Jeremy, who has always expected great things and made the many little
(and sometimes big) sacrifices to help co-juggle family and two intense careers.
Jessica thanks the teachers and mentors who have selflessly guided and shaped her into who
she is today. The late Fred Margolin showed her grace and compassion in caring for patients
across the entire socioeconomic spectrum, and the late Randy Hawkins personified to her the
joy of discovery and learning. Ed Sickles provided her with mobile screening mammography
data over two decades ago and started her breast imaging career. Jessica has had the good
fortune to work with and learn from wonderful colleagues in the Society of Breast Imaging, at
Massachusetts General Hospital, University of California San Francisco, Brigham and Women’s
Hospital, Dana-Farber Cancer Institute, California Pacific Medical Center, and now
MD Anderson Cancer Center. She is grateful to her international colleagues for demonstrating
to her the true meaning of commitment and dedication to breast cancer care, even in
challenging environments of limited resources. Jessica is indebted to her many close-knit
extended family members (Uncle Fred, Auntie Esme, Steve, Logan, Madeline, Lucas) and
incredible lifelong friends for sharing in her happy times and supporting her during sad times.
And she is always and forever thankful for having the most amazing family in the world, full of
unconditional support and love: Her three siblings and confidants, Waishan, Melissa, and Wilson,
and her mother and father, Hau Wan and Pui Chee Leung, who courageously built a new life in
a new country and provided limitless educational opportunities for their children, and who have
consistently and purely demonstrated that scholarly pursuit is its own reward.
WAB, JWTL
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Contributing Authors
Michael P. Andre, PhD, Lauren Q. Chang Sen, MD Laura Heacock, MD
FAAPM, FAIUM Assistant Professor Assistant Professor
Professor of Radiology Department of Diagnostic Radiology Department of Radiology
Department of Radiology The University of Texas Breast Imaging Section
UC San Diego MD Anderson Cancer Center NYU Langone School of Medicine
La Jolla, California Houston, Texas New York, New York
Hanieh Attari, MD Mark W. Clemens, MD, FACS Regina J. Hooley, MD, FSBI
Research Fellow Associate Professor Associate Professor
Radiology Department Department of Plastic Surgery Vice Chair of Clinical Affairs
Weil Cornell Imaging at The University of Texas Department of Radiology and
NewYork-Presbyterian MD Anderson Cancer Center Biomedical Imaging
New York, New York Houston, Texas Yale School of Medicine
New Haven, Connecticut
Ethan O. Cohen, MD
Sushil Beriwal, MD
Assistant Professor Zachary D. Horne, MD
Professor
Department of Radiation Oncology Department of Diagnostic Radiology Department of Radiation Oncology
University of Pittsburgh The University of Texas Allegheny Health Network
School of Medicine MD Anderson Cancer Center Cancer Institute
UPMC Magee-Womens Hospital Houston, Texas Pittsburgh, Pennsylvania
Residency Program Director and
Katie M. Davis, DO Golbahar Houshmand, MD
Director of Brachytherapy
UPMC Hillman Cancer Center Assistant Professor Assistant Professor
Pittsburgh, Pennsylvania Department of Clinical Radiology and Department of Radiology
Radiological Sciences University of Pittsburgh
Rohit Bhargava, MBBS Vanderbilt University Medical Center School of Medicine
Professor of Pathology Nashville, Tennessee UPMC Magee-Womens Hospital
University of Pittsburgh Pittsburgh, Pennsylvania
Stamatia Destounis, MD, FACR,
Interim Chief of Pathology
UPMC Magee-Womens Hospital FSBI, FAIUM Becky Hwang, DO
Pittsburgh, Pennsylvania Elizabeth Wende Breast Care Diagnostic Radiologist
Clinical Professor Radiologic Consultants
Dalliah M. Black, MD, FACS Department of Imaging Sciences Greensburg, Pennsylvania
Associate Professor University of Rochester
Megha Madhukar Kapoor, MD
Department of Breast School of Medicine & Dentistry
Surgical Oncology Rochester, New York Assistant Professor
The University of Texas Department of Radiology
MD Anderson Cancer Center Melissa Durand, MD The University of Texas
Houston, Texas Assistant Professor MD Anderson Cancer Center
Department of Radiology and Houston, Texas
Whitney S. Boyce, MD Biomedical Imaging
Henry M. Kuerer, MD,
Breast Imaging Fellow Yale School of Medicine
Department of Diagnostic Radiology New Haven, Connecticut PhD, FACS
The University of Texas Executive Director, Breast Programs
MD Anderson Cancer Center Mohammad Eghtedari, MD Anderson Cancer Network
Houston, Texas MD, PhD PH and Fay Etta Robinson Endowed
Distinguished Professor in
Assistant Professor
Reni Butler, MD Cancer Research
Department of Radiology
Assistant Professor Division of Surgery
Breast Imaging Section
Department of Radiology and Department of Breast
UC San Diego Health
Biomedical Imaging Surgical Oncology
La Jolla, California
Yale School of Medicine Director, Breast Surgical Oncology
New Haven, Connecticut Amy M. Fowler, MD, PhD Training Program
The University of Texas
Assistant Professor
MD Anderson Cancer Center
Department of Radiology
Houston, Texas
University of Wisconsin School of
Medicine and Public Health
Madison, Wisconsin
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Vilert Loving, MD Kanchan Phalak, MD Uzma Waheed, MD
Chief of Breast Imaging Assistant Professor Assistant Professor
Division of Diagnostic Imaging Department of Diagnostic Radiology Department of Radiology
Banner MD Anderson Cancer Center The University of Texas University of Pittsburgh
Gilbert, Arizona MD Anderson Cancer Center School of Medicine
Adjunct Assistant Professor Houston, Texas UPMC Magee-Womens Hospital
Department of Diagnostic Radiology Pittsburgh, Pennsylvania
The University of Texas Martin Prince, MD, PhD, FACR
MD Anderson Cancer Center Professor Shafik N. Wassef, MD
Houston, Texas Department of Radiology Clinical Instructor
Cornell and Columbia Universities Department of Radiology
Lisa Madlensky, PhD, CGC New York, New York UPMC Magee-Womens Hospital
Professor University of Pittsburgh Medical Center
Department of Medicine Rebecca Rakow-Penner, Pittsburgh, Pennsylvania
UC San Diego MD, PhD
Director, UCSD Family Cancer Nicole S. Winkler, MD
Assistant Professor
Genetics Program Assistant Professor
Department of Radiology
La Jolla, California Department of Radiology and
UC San Diego
Imaging Sciences
La Jolla, California
Laurie Margolies, MD, FSBI, University of Utah
FACR Ana Paula Refinetti, MD Huntsman Cancer Institute
Salt Lake City, Utah
Chief of Breast Imaging Assistant Professor
Mount Sinai Health System Department of Breast Surgical Oncology
Professor The University of Texas
Department of Radiology MD Anderson Cancer Center
Icahn School of Medicine at Houston, Texas
Mount Sinai Additional
New York, New York Erin Roesch, MD
Assistant Clinical Professor Contributing
Ray Cody Mayo, MD Department of Hematology/Medical
Assistant Professor Oncology Authors
Department of Diagnostic Radiology Comprehensive Breast Health Center
The University of Texas Moores Cancer Center at
MD Anderson Cancer Center UC San Diego Health
Houston, Texas La Jolla, California Maria L. Anello, DO
Katherine McElroy, BA Marion E. Scoggins, MD Rosalind Candelaria, MD
MD Candidate Associate Professor
Selin Carkaci, MD
McGovern Medical School at Department of Diagnostic Radiology
The University of Texas Health Science The University of Texas Amy Lynn Conners, MD
Center at Houston MD Anderson Cancer Center
Houston, Texas Houston, Texas Basak E. Dogan, MD, FSBI
Michael Z. Gilcrease, MD, PhD
Linda Moy, MD, FSBI Robin N. Sobolewski, MD
Professor Chief of Breast Imaging Deanna L. Lane, MD
Department of Radiology Department of Diagnostic Radiology
Amal Malhem-Bertrandt, MD
Breast Imaging Section Allegheny Health Network
Center for Advanced Imaging Pittsburgh, Pennsylvania
Cecilia L. Mercado, MD, FACR,
Innovation and Research
NYU Langone School of Medicine Lori Strachowski, MD FSBI
New York, New York Clinical Professor
Lumarie Santiago, MD
Department of Radiology and
Haydee Ojeda-Fournier, MD
Biomedical Imaging Wei Tse Yang, MBBS, FRCR,
Professor UC San Francisco
Department of Radiology San Francisco, California FSBI
Medical Director
Breast Imaging Section Hilda Tso, DO
UC San Diego Health Assistant Professor
La Jolla, California Department of Diagnostic Radiology
The University of Texas
Hayley Oligane, DO
MD Anderson Cancer Center
Clinical Instructor Houston, Texas
Department of Radiology
UPMC Magee-Womens Hospital
Pittsburgh, Pennsylvania
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Foreword
Some say that medical books are a thing of the past; in the era of widely available YouTube videos, TED
Talks, and PubMed abstracts, is there still space and time for the traditional medical textbook? The fields
of medicine, radiology, and breast imaging indeed are evolving at an astonishing pace. Nevertheless,
when multiple factors align to create a cohesive whole, a medical textbook still can have great value. This
3rd edition of Diagnostic Imaging: Breast is such a textbook.
Drs. Wendie Berg and Jessica Leung, editors of this impressive work, have assembled a diverse group
of breast imaging and breast cancer care specialists, national and international, from a wide range of
practices, with the common mission of producing an up-to-date, interesting, accessible, and clinically
useful textbook. It is truly encompassing, in total over 1,200 pages, with even more content in the
digital version. It covers the entire spectrum of breast anatomy, physiology, and pathophysiology. Topics
ranging from fibrocystic change to PASH to radial scar to atypias to cancers (both common and rare)-all
are discussed in full.
Importantly, this textbook is both evidence based and clinically grounded. Numerous recent peer-reviewed
reference citations are provided with each chapter. Text is substantiated with data when appropriate.
Clinical considerations, such as signs and symptoms, natural history, and clinical outcomes, are included in
nearly all chapters. Furthermore, there is a specific section on Signs and Symptoms, enabling the clinical
care provider, as well as the clinical breast imager, to approach and utilize this textbook with ease. What
sets this textbook apart from most others is its bullet-point communication style in short, targeted
chapters, a highly effective approach to delivering teaching “pearls” succinctly and meaningfully.
This edition of the textbook has been updated to include the latest scientific evidence, classifications,
protocols, and guidelines, including new techniques, such as contrast-enhanced mammography and
abbreviated MR imaging for breast cancer screening, newly identified pathogenic genetic variants, and
the most current treatment concepts, such as neoadjuvant chemotherapy, targeted axillary dissection,
and oncoplastic reconstruction. Entirely new chapters have been added, including, but not limited to,
tailored aspects of screening, patient genetic and tumor genomics testing, preoperative axillary node
localization, and gadolinium safety.
A particular strength of this textbook is the plethora of images, carefully selected and effectively
presented. Most of the images are new to this edition. Beyond the demonstration of anatomy and
pathology, the images tell the full story of breast imaging. Some of the cases are straightforward and
classic, while others are rare and dramatic; all are a pleasure to view and review.
Beyond updated and new topics, this third edition is characterized by a new philosophy. Whereas the
traditional surrogate markers for breast cancer prognosis are size, nodal status, and stage, biological
aspects are now recognized as being important in addition to anatomical extent. This is reflected in
the eighth edition of the AJCC Cancer Staging Manual. The new staging system, along with this new
philosophy, is discussed and reflected throughout the textbook. Functional imaging [such as molecular
imaging of HER2(+) cancers] is stressed, along with structural imaging, and there are specific chapters on
the significance of biomarkers and tumor genomics. Information on biomarkers (ER, PR, HER2, Ki-67) is
provided in the figure legends for nearly all cancer cases throughout the textbook.
Dr. Berg, Dr. Leung, and their colleagues have created a highly effective, practical, readily approachable,
and comprehensive work. Breast imaging (basics and advanced), genetics, screening guidelines,
multimodality and multidisciplinary treatment—they are all there. The unique style of this 3rd edition of
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