Swe on breast cancer in dense breast with considerations on tnm staging
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This case shows how dense breast can hinder cancer at mammography and the important role of US and SWE elastography in situation like this. SWE could be the most reliable tool for the measurement of the 'T' parameter of TNM staging of breast cancer, especially if performed with 3D probe.
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Swe on breast cancer in dense breast with considerations on tnm staging
- 1. Antonio Pio Masciotra Campobasso – Molise – Italy Email antoniomasciotra@yahoo.it Website www.masciotra.net YouTube Channel https://www.youtube.com/channel/UCgCj21nKGAhR997Ia3-QegQ Breast cancer in dense breast as seen at Shear Waves Elastography with discussion about the ‘T’ measurement in TNM staging
- 2. Woman 48 years old feeling a little pain in upper quadrants of her right breast. Only mammography performed at the first exam. 9 months later she feels a nodule between the upper quadrants of the same breast. 27/08/2013 12/05/2014
- 3. 27/08/2013 12/05/2014 27/08/2013 12/05/2014 Only right breast images in comparison are showed with closeup details. Very dense breast far to offer well valuable signs. Maybe the only differences perceivable are in retromammary fat area that in the second exam seems to host ‘something new’ at least in CC view (arrows). Then US exam was performed showed in next slides.
- 4. Woman 48 years old
- 5. Woman 48 years old Feature (kPa) Nodule Mean stiffness 86-118 Maximum stiffness 135-299 Minimum stiffness 0,1-95 Standard Deviation 9-64 Hypoechoic area 0,42 cm² Stiffest area 1,17 cm² The tumor area traced according echogenicity is far smaller than the area traced according the stiffness
- 6. Woman 48 years old Feature Echogenicity based data Stiffness based data Perimeter 5,42 cm 6,63 cm Area 1,52 cm² 2,45 cm² Diameter 1 1,48 cm 2,19 Diameter 2 1,45 cm 1,88 The tumor area traced according echogenicity is large smaller than the area traced according the stiffness.
- 7. Woman 48 years oldPlane Feature Echogenicity based data Stiffness based data Difference (%) Coronal Perimeter 5,89 cm 5,78 cm -1,87% Area 1,47 cm² 2,06 cm² 40,1% Axial Perimeter 3,03 cm 6,48 cm 80,9% Area 0,47 cm² 1,35 cm² 187,2% Sagittal Perimeter 4,06 cm 5,39 cm 32,8% Area 0,69 cm² 1,71 cm² 147,8% The tumor’s dimensions traced according echogenicity are always smaller than the ones traced according the stiffness in all planes. Breast cancer is staged by the TNM System : Tumor Size, node status, and metastasis. Tumor Size is divided into four classes based on the maximum diameter: T-1 is from 0 to 2 centimeters. T-2 is from 2 to 5 cm. T-3 is greater than 5 cm . T-4 is a tumor of any size that has broken through (ulcerated) the skin, or is attached to the chest wall. So it would be wise to check which is the most reliable imaging technique of measurement of the ‘T’ parameter relating it to the more accurate prognostic significance and to the right choice in the therapeutic approach. T1mi Tumor ≤1 mm in greatest dimension. T1a Tumor >1 mm but ≤5 mm in greatest dimension. T1b Tumor >5 mm but ≤10 mm in greatest dimension. T1c Tumor >10 mm but ≤20 mm in greatest dimension.
- 8. Antonio Pio Masciotra Campobasso – Molise – Italy Email antoniomasciotra@yahoo.it Website www.masciotra.net YouTube Channel https://www.youtube.com/channel/UCgCj21nKGAhR997Ia3-QegQ Breast cancer in dense breast as seen at Shear Waves Elastography with discussion about the ‘T’ measurement in TNM staging