Search results for: dcis-of-the-breast

DCIS of the Breast The Value of Preoperative MRI

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Abstract: Introduction: Ductal carcinoma in situ (DCIS) of the breast is commonly treated surgically. The intent of this study was to evaluate whether preoperative MRI could add to mammography in predicting the extent of the disease. Methods: A series of patients with DCIS attending our surgical clinic for preoperative assessment were offered MRI as part of a prospective study. The extent of the disease indicated by mammography and MRI was compared with histopathology after definitive treatment. The null hypothesis was that MRI does not add to mammography in accurately predicting disease extent. Results: Fifty patients make up the basis of this report. Mammography was concordant with the pathology in 31/50. MRI and mammography combined were concordant in 43/50. This is a statistically significant difference ( P = 0.01, Fisher's exact test). Upstaging to mastectomy by MRI was correct in 7/8 patients, but downstaging was correct in only 2/4. Conclusions: The null hypothesis is rejected. MRI does add to mammography in accurately predicting the extent of DCIS. Upstaging by MRI is usually reliable.

Ductal Carcinoma in Situ of the Breast

Author : Carlo Mariotti
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This book provides up-to-date information on all aspects of ductal carcinoma in situ of the breast, including epidemiology, imaging, pathologic and biologic features, interventional diagnostics, nonpalpable lesion localization, and treatment. Surgical procedures are described in detail, covering breast conservation techniques, conservative mastectomies, breast reconstruction options, and axillary surgery. Guidance is provided on how to ensure adequacy of surgical excision and avoid local recurrence when performing breast conservation surgery and how to minimize morbidity from axillary surgery. The role and techniques of partial and whole breast irradiation are described, and the use of adjuvant systemic therapy options, including endocrine therapy and chemotherapy, is explained. A concluding chapter addresses the issue of recurrence and its current management. This book, designed for ease of consultation, will be of value for all involved in the multidisciplinary care of patients with ductal carcinoma in situ of the breast, including surgeons, medical oncologists, pathologists, radiologists, and radiotherapists.

Ductal Carcinoma In Situ and Microinvasive Borderline Breast Cancer

Author : Lisa A. Newman
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This volume reviews the evolution of information regarding the epidemiology of DCIS and its modes of detection, as well as treatment options as a function of both clinical trial data and ongoing investigational therapeutic prospects. Several of the challenging and clinically-relevant scenarios of DCIS that appear in daily practice is discussed, including the difficulties of distinguishing “true” DCIS from borderline patterns of other breast diseases and the therapeutic implications of differentiating these various diagnoses. Particular attention is paid to pathologic evaluation of DCIS, including histologic patterns and the importance of margin evaluation/margin control. The text also explores the data regarding DCIS in medical research in hereditary susceptibility for breast cancer and race/ethnicity-associated disparities in breast cancer. Written by experts in the field, Ductal Carcinoma In Situ and Microinvasive/Borderline Breast Cancer is a comprehensive, state-of-the art review of the field, and serves as a valuable resource for clinicians, surgeons and researchers with an interest in breast cancer.

Breast and Axilla Treatment in Ductal Carcinoma In Situ

Author : Ambrogio P. Londero
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Ductal carcinoma in situ (DCIS) represents a challenge for the breast unit team, beginning from its difficult radiological detection and continuing with its controversial multimodal treatment and management. With the introduction of the mammographic screening, DCIS has become a common diagnosis. In fact, today DCIS is mostly identified by mammography or magnetic resonance imaging (MRI). The increased prevalence of DCIS diagnosis, in the past, raised the problem of the therapeutic management. In this chapter, the breast and axillary surgery in case of DCIS and the most controversial aspects regarding DCIS management are reviewed based on international guidelines and on the current literature.

DCIS of the Breast

Author : John Boyages
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This is the second book by Professor John Boyages for patients who have been diagnosed with cancer. The first book was designed for breast cancer patients and this second project for patients with DCIS (ductal carcinoma in situ) of the breast. The book is written in an approachable style, with lots of photographs and patient stories which serves both to illustrate medical points and break up the text, making it more readable. The book is divided into three parts and has 20 control points where patients are guided through the process of making very important decisions regarding their diagnosis and treatment. John uses many botanical references and metaphors to explain difficult concepts and present information in a less threatening way.

Margins in Breast Cancer How Much is Enough

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Abstract : The appropriate negative margin width for women undergoing breast‐conserving surgery for both ductal carcinoma in situ (DCIS) and invasive carcinoma is controversial. This review examines the available data on the margin status for invasive breast cancer and DCIS, and highlights the similarities and differences in tumor biology and standard treatments that affect the local recurrence (LR) risk and, therefore, the optimal surgical margin. Consensus guidelines support a negative margin, defined as no ink on tumor, for invasive carcinoma treated with breast‐conserving therapy. Because of differences in the growth pattern and utilization of systemic therapy, a margin of 2 mm has been found to minimize the LR risk for women with DCIS undergoing lumpectomy and radiation therapy (RT). Wider negative margins do not improve local control for DCIS or invasive carcinoma when they are treated with lumpectomy and RT. Re‐excision for negative margins should be individualized, and the routine practice of performing additional surgery to obtain a wider negative margin is not supported by the literature. Cancer 2018;124:1335‐41 . © 2018 American Cancer Society . Abstract : In today's era of multimodality therapy for invasive and in situ breast carcinoma, the margin status is one of a number of factors affecting the local recurrence risk. Current data support a negative margin width of no ink on tumor to minimize the local recurrence risk for invasive breast cancer and a margin of 2 mm for women with ductal carcinoma in situ treated with lumpectomy and radiation therapy.

Breast MRI

Author : Laura Liberman
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Drs. Elizabeth Morris and Laura Liberman, two rising stars in breast MRI from the Memorial Sloan-Kettering Cancer Center, edited this superbly illustrated practical guide. Introductory chapters are devoted to diagnosis and cover the basics of performing breast MRI exams, setting up a breast MR program, and understanding clinical indications. Additional chapters discuss breast interventional procedures. A diagnostic atlas completes the volume. Radiologists, residents, and fellows will benefit from this guide's thorough examination of image interpretation, which highlights pitfalls that specialists must recognize.

Epithelial Remodelling in Early Breast Cancer Progression and Regression

Author : Aislynn Hunt
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"Ductal carcinoma in situ (DCIS) is the earliest stage of breast cancer (Stage 0) and represents roughly 20% of all diagnosed breast cancer cases. DCIS lesions exhibit a multilayered luminal epithelial layer, which aberrantly expresses signalling pathways that contribute to cancer progression, surrounded by a myoepithelial layer that is thought to act as a barrier to cancer progression. However, factors that enable 14-50% of DCIS lesions to progress to invasive cancer are poorly understood, which has resulted in an epidemic of overtreating patients with DCIS and exposing them to significant side-effects. In this project, I focused on the epithelial remodelling of mammary ducts that occurs during breast cancer progression and regression. Using an inducible murine model, I observed that removal of the driving oncogene in early DCIS lesions was sufficient to revert the morphology and signalling pathways of mammary ducts to a pre-cancer state. The results from this body of work reveal significant plasticity in DCIS lesions. Moreover, use of intraductal injections to create in vivo and ex vivo models of DCIS to invasive ductal carcinoma (IDC) progression revealed that myoepithelial cells undergo morphologic and kinetic changes in response to cancer-cell secreted factors. This confirms the dynamic nature of the myoepithelial layer and its active role in preventing cancer cell dissemination. I also found that cancer cell adjacency is associated with loss of myoepithelial layer integrity. I envision that this foundation of knowledge could be built upon by additional studies and pharmaceutical testing, such future DCIS treatment capitalizes on this plasticity to revert pre-invasive lesions into functionally normal mammary tissue. Further understanding of the mechanism of communication between myoepithelial cells and cancer cells could potentially be used to predict DCIS most at risk of progression or to prevent cancer cell invasion out of the mammary ductal structure and therefore improve patient quality of life and survival"--

Breast Cancer Management and Molecular Medicine

Author : Martine J. Piccart
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Tailoring treatment for individual breast cancers is no longer a dream and is now the main goal for current research. This book gives an overview of the most recent techniques, agents and approaches for breast cancer and the individualization of treatment. Particular attention is given to organ-specific tailored approaches, specific populations, patients’ preferences and rehabilitation. Contributions from experts focus on the biomedical research behind the transfer of molecular biology knowledge into the clinical management of patients. This has led to increased survival as well as improved quality of life. The book gives an overview of the latest achievements in breast cancer and their use in clinical practice.

Breast Cancer

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Radiation Medicine Rounds is a trinary, hard cover, periodical designed to provide an up-to-date review of a dedicated radiation medicine topic of interest to clinicians and scientists who are involved in the care of patients receiving radiotherapy. It is intended to serve as both a reference and instructional tool for students, housestaff, fellows, practicing clinicians, medical physicists, cancer biologists, radiobiologists, and interdisciplinary colleagues throughout the oncology spectrum. This issue of Radiation Medicine Rounds discusses the more salient topics surrounding the role of radiation therapy in breast cancer. The specialty of radiation therapy has increased in complexity over the years, yet as technology improves, the goal of improving outcomes while decreasing toxicity remains critical. Breast Cancer provides the practitioner with a full current overview of the present best practices and recent research in management of this complex and challenging cancer.

Advanced Therapy of Breast Disease

Author : Geoffrey L. Robb
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The information surveyed in this volulme is designed to provide the clinician with an expert overview of the current state of the art in breast cancer management. It should provide at least a flavor of the major paradigm shift that is occurring in this rapidly evolving field. Breast cancer management is moving away from a "kill or cure" model and advancing toward a model focused on strategies of prevention and of long-term management of breast cancer as a chronic disease. The acceptance of this new paradigm by patients and clinicians alike will represent a major focus for the twenty-first century.

Breast Surgery

Author : W. G. Cance
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The volume provides a comprehensive review of the surgical aspects of breast disease from the leaders in their fields. Each chapter offers a discussion of a certain topic or field along with the author's assessment of future directions. The topics range from the surgical management of high risk patients, a well as patients with DCIS and invasive cancer. Chapters include the status of sential lymphadenectomy as well as managment of locally advanced breast cancer, with other topics studying breast surgical training, definition of optimal biopsy methodology, breast reconstruction, chemoprevention, as well as complications of breast surgery and medical/legal issues in breast cancer. This should provide readers with a state-of-the-art discussion of the major surgical issues related to breast disease.

Evaluating Ductal Carcinoma in Situ Progression Via Tissue Oxygenation and Perfusion Using Photoacoustic and Contrast Enhanced Ultrasound

Author : Ryan Margolis
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Breast cancer accounts for 30% of all cancer in women with an estimated 266,000 new cases and over 40,000 deaths in 2018. In the U.S., breast cancer treatments exceed $16.5 billion per year. The gold standard for treatment commonly involves a combination of breast conserving surgery and radiation. Treatments are only successful if the cancers are accurately detected. Breast cancers detection is commonly done through mammography or manual palpation. While mammography has reduced the death rate and allowed for earlier treatments, it is limited by dense breast tissue. Furthermore, about 50% of women experience false-positives. It is reported that approximately 30% of early stage breast cancer, also referred to as ductal carcinoma in situ (DCIS), is over diagnosed and overtreated, causing physical and emotional distress. This thesis aims to address the clinical need for predictive precursors for the aggressiveness and development of DCIS to invasive breast cancer by measuring tissue oxygenation and perfusion using photoacoustic and contrast-enhanced ultrasound imaging. Furthermore, exercise has been proposed as a mechanism to not only reduce the risk of breast cancer, but its progression as well. Therefore, the effects of voluntary physical exercise will be evaluated through the aforementioned parameters above. Mouse models consisting of FVB/NJ mice (n=20) and Tg(C3-1-TAg)cJeg mice (n=10) were evenly divided into exercise and control subgroups, where the exercise groups had access to an exercise wheel. The Tg(C3-1-TAg)cJeg (SV40 Tag) mouseline is genetically predisposed to develop DCIS. Mice were weighed biweekly. Tissue perfusion was measured using the combination of ultrasound contrast agents and high frequency nonlinear imaging. Time intensity curves were generated from perfusion flow within tumor ROIs to extract wash-in rate and area under the curve values. Average SO2 values were compared for tissue oxygenation from photoacoustic images. There was a significant difference between the exercise and control subgroups for the FVB/NJ and SV40 Tag mice. For the FVB/NJ mice, the exercise group exhibited lower weight changes than the control group (0.43 ℗ł 0.70 g vs. 0.99 ℗ł 2.31 g, respectively, p = 0.002). The SV40 Tag mice demonstrated similar differences in weight gain (2.67 ℗ł 1.38 g vs. 3.36 ℗ł 1.36 g, respectively, p = 0.006). There were no differences between the exercise and control subgroups of the FVB/NJ mice with regards to tissue oxygenation (5.16 ℗ł 23.68 % vs. 10.93 ℗ł 27.67 %, respectively, p=0.947). However, for the SV40 Tag mice, the animals with access to voluntary exercise showed mammary tissue more indicative of a hypoxic environment than the control group (-15.64 ℗ł 30.95 % vs. 21.73 ℗ł 27.10 %, respectively, p=0.061). Neither the FVB/NJ or SV40 Tag mice displayed any differences between the exercise or control subgroups when measuring perfusion using contrast-enhanced ultrasound. The WIR was greater for the FVB/NJ (p = 0.685) and SV40 Tag (p = 0.659) exercise groups than the control groups. Likewise, the AUC held a similar relationship between the two subgroups for the FVB/NJ (p = 0.073) and SV40 Tag (p = 0.523) mice. The higher WIR suggest higher vascularization in the exercise groups. Lastly, preliminary results did not support any significant differences between tumor sizes, although the control group did exhibit higher weekly tumor growth (p = 0.902). DCIS-like tumors were visibly seen in all mice at 12 weeks of age, while invasive cancer was indicative of the increasing weekly tumor size at weeks 15. Preliminary results show the potential for tissue oxygenation to be predictive precursor of DCIS progression. By predicting DCIS growth, the proper treatments can be determined to avoid the unnecessary physical, psychological, and financial costs caused by over diagnosis and overtreatments of DCIS.

Breast MRI An Issue of Magnetic Resonance Imaging Clinics E Book

Author : Linda Moy
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This publication presents topics on Current Clinical Indications for Breast MRI; How to set up breast MRI practice; MR-BIRADS Lexicon; Optimization of breast MRI at 1.5 Tesla(T) and at 3 Tesla; Role of MRI in evaluating extent of disease; Update on Screening breast MRI in high risk women; MRI of DCIS; Role of breast MRI in the assessment of Invasive lobular carcinoma; Breast MRI Interventions: Indications, Technique, and Histologic Correlation; Role of Breast MRI in problem-solving; Benign lesions detected on breast MRI; Clinical Oncologic Perspective of Breast MRI; Role of breast MRI in neo-adjuvant chemotherapy.

Chemoprevention of Breast Cancer

Author : Charles W. Boone
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Patient Pictures Breast Cancer

Author : Mohammed R.S. Keshtgar
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'Patient Pictures: Clinical drawings for your patients' are: • time-saving books for doctors and nurses. Use them when describing medical conditions and treatments to your patients. • easy to photocopy. The stand-alone pages can be given to the patient or carer to take home and read. • reviewed by lay people and medical professionals, to make sure patients get the information they want.

The Breast E Book

Author : Kirby I. Bland
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The Breast: Comprehensive Management of Benign and Malignant Diseases, 4th Edition, by Kirby I. Bland, MD, and Edward M. Copeland, III, MD, is a surgical reference that offers the most comprehensive, up-to-date resource on the diagnosis and management of, and rehabilitation following, surgery for benign and malignant diseases of the breast. With its multidisciplinary approach, sweeping updates, new contributors, and authoritative guidance, you’ll have exactly what you need to inspire patient confidence and provide the best possible outcomes. Features multidisciplinary advice from experts in surgery, radiation and medical oncology, pathology, molecular biology, pharmacokinetics, and genetics for a well-rounded perspective to enhance patient outcomes. Includes more than 1,500 figures and tables that offer high quality depictions of surgery and treatment procedures. Offers step-by-step guidance through both text and clinical boxes that makes the material relevant to everyday practice. Provides cross-referencing between chapters, as well as references to carefully selected journal articles, that makes further research easier. Uses a new full-color design to highlight key areas of the text and help you focus on important concepts. Presents updated coverage including an expanded section on pathology...and new chapters on granular cell tumors, targeted therapies, integration of radiotherapy and chemotherapy to keep you current. Includes revised chapters on the psychosocial consequences of breast cancer, lifestyle interventions for breast cancer patients, and patient and family resources that equip you to offer complete and compassionate care. Provides additional information on genetics to keep you up to date with the latest genetic discoveries linked to breast cancer and breast diseases. Features the work of many new contributors who provide the latest and freshest perspectives.

Breast Imaging Expert Radiology Series E Book

Author : Lawrence W. Bassett
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Imaging of the Breast, by Drs. Lawrence Bassett, Mary Mahoney, Sophia Apple, and Carl D'Orsi, enables you to more accurately interpret the imaging findings for even your most challenging cases. A comprehensive look at breast imaging, it correlates radiologic images with pathology slides to strengthen the accuracy of your diagnosis. This entry in the Expert Radiology Series also addresses topics such as appropriateness criteria for various imaging approaches, the BI-RAD quality assessment and reporting tool, and image-guided interventional procedures. Confidently interpret breast imaging findings by looking at how various radiologic presentations correlate with pathology studies. Make the best imaging decisions with comprehensive coverage of the appropriateness criteria for various imaging modalities. Comply with accepted reporting standards thanks to in-depth information on Breast Imaging-Reporting and Data System. Enhance your interventional radiology skills with detailed guidance of these techniques. View breast pathology clearly with full-color images throughout.

Medical Therapy of Breast Cancer

Author : Zenon Rayter
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There have been very significant advances across many areas of the study, investigation and treatment of breast cancer. This publication surveys how scientific advances have influenced, improved and extended therapeutic options. The volume spans prevention, screening, genetics, and treatment of pre-invasive breast cancer, before focusing in depth on management of established breast cancer. This includes chapters on the various therapeutic options available and their role in treating breast cancer from the very earliest stage through to advanced and metastatic breast cancer. In addition, the text looks forward at the potential for emerging experimental strategies to become adopted into medical management in the future. The volume concludes with a chapter on palliative care. This wide-ranging account will be essential for breast cancer specialists, trainees in oncology and clinical research scientists.

Management of Breast Diseases

Author : Ismail Jatoi
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In 2002, Lippincott published the Manual of Breast Diseases, edited by Professor Ismail Jatoi. The current book, Management of Breast Diseases, is an adaptation of that manual, with Professor Manfred Kaufmann of the Goethe-University of Frankfurt serving as co-editor. Most of the chapters from the original manual have been either extensively revised or discarded, and several new chapters added. This text contains more material than the original manual, but it is still intended as a basic guide for the wide spectrum of clinicians (surgeons, gynecologists, oncologists, radiation onco- gists, internists, general practitioners) who treat breast diseases, both benign and malignant. To compile this text, we assembled experts from throughout the world. Thus, this text provides not only a broad overview of breast diseases, but also highlights diff- ent perspectives from different parts of the world. Yet, it is worth noting that the management of breast cancer is now largely predicated on evidence-based medicine. Several large, randomized prospective trials have demonstrated the ef? cacy of breast cancer screening and chemoprevention. Other large trials have addressed the impact of systemic therapy, radiotherapy, and variations in local therapy on breast cancer mortality. Many of these landmark trials are discussed in this text, and they clearly have had a bene? cial effect. Indeed, since about 1990, breast cancer mortality rates have declined substantially in most industrialized countries, and this trend is expected to continue in the years ahead.