Download Background on: Breast Cancer, X

Background on: Breast Cancer,
X-Ray and MRI Mammography
Ernesto Coto
Vienna University of Technology
Institute of Computer Graphics and Algorithms
Computer Graphics Group
Ernesto Coto - Institute of Computer
Graphics and Algorithms
Introduction
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First stage of a research about the State
of the Art on Mammography for Breast
Cancer Detection
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Focuses on the background knowledge
about Breast Cancer, X-Ray and MRI
Mammography
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: Breast Cancer
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Cancer is a general term that is used to describe a group of more
than 100 diseases that cause cells in the body to divide and
reproduce abnormally without control
These cells may join together to form a mass of extra tissue
known as a tumor. Tumors can be malignant or benign
Malignant tumors can break away from tumors and travel, or
metastasize
Breast cancer refers to a malignant tumor that has developed
from breast cells
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: Breast Cancer
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The female breast has two main components: glandular tissue
and connective tissue
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There are two general categories
of breast cancer
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Non-invasive (or in situ)
cancer confined to lobules or ducts
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Invasive
cancer spread to fatty connective tissue
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: Breast Cancer
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When breast cancer is detected before it has spread to lymph
nodes or to other parts of the body, the 5-year survival rate is
97%
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Early detection and early treatment can improve the chances of
surviving breast cancer. Currently, mammography is the best tool
available to detect the earliest warning signs of breast cancer
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
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A mammogram is an x-ray examination of the breasts, used to
detect and diagnose breast diseases
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Screening mammography is used as a preventive measure for
women who have no symptoms of breast disease
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Diagnostic mammography involves additional x-rays of the breast
to provide different views of the suspicious area, if an abnormality
is detected during screening mammography, or in women with
breast complaints
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The x-rays can be taken at different angles tailored to the specific
area of abnormality. In addition, magnification views or spot
compression can be used to make the area easier to evaluate
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
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Mammography procedure
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Special x-ray machines developed exclusively for breast
imaging are used to produce mammography films. These
machines use very low doses of radiation and produce highquality x-rays
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
Mammography procedure
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1.
The patient wears an open wrap and undress above the
waist
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
Mammography procedure
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2.
Compressing the breast is necessary to obtain the best
image
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
Mammography procedure
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3.
When the breast is positioned and compression is
complete, the technologist will leave the room or step
behind a screen and turn on the x-ray source
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
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Mammography procedure
4.
Magnification views or spot compression
could be performed too
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
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Results
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Calcifications are tiny calcium deposits within the breast
tissue. Calcifications are classified as microcalcifications
(< 1/50 inchs) or macrocalcifications (larger)
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Masses
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Can be solid or liquid (Cyst)
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
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Staging
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Staging is the process used to determine the extent a cancer has
spread beyond the primary site
The system used to describe staging is the Staging System of the
American Joint Committee on Cancer (or TNM system), it evaluates
three components to determine the stage of a cancer:
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T = The extent of the tumor, expressed in a numerical value from 0 to 4.
Higher T numbers indicates a larger tumor or more extensive spread
N = the extent to which the cancer has spread to lymph nodes near the
breast and the degree to which the affected nodes are fixed to other
structures under the arm. It is expressed in a numerical value from 0 to 3,
with the higher number denoting more extensive spread
M = the extent to which the cancer has metastasized to distant organs or
to lymph nodes that are not next to the breast. It is shown in a numerical
value from 0 to 1, with 1 indicating the most extensive spread
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
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Mammography cannot determine whether an abnormal area is
cancer, but it can provide guidance for further screening or
diagnostic tests.
Results of mammograms are reported using a standardized
system called the Breast Imaging Reporting and Data System
(BIRADS)
Results range from “Assessment incomplete” to “Highly
Suggestive of Malignancy”
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
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Despite Mammography is acknowledged to be the most effective
method of screening for breast cancer, the interpretation of
screening mammograms is challenging
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The combination of viewing a large number of cases, radiologist
fatigue and the complex image structure of the breast on a
mammogram can result in false negative mammogram readings
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Several retrospective studies have shown that 20% to 40% of
breast cancer goes undetected at the screening stage
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In addition, finding cancer does not always mean saving lives
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: X-Ray Mammography
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Less common diagnostic procedures
Magnetic Resonance Imaging (MRI)
 Digital Mammography
 Positron Emission Tomography
 Ultrasound
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Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: MRI Mammography
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Magnetic Resonance Imaging (MRI) can be used to
obtain three dimensional images of the inner parts of
the human body, without using X-rays
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MRI breast imaging is a supplemental tool, in addition
to mammography, to help diagnose breast cancer
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MRI advantages over X-ray or CAT
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No radiation
The ability to generate arbitrary three-dimensional views of an
object of interest
The possibility to generate images of “soft“ body structures
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: MRI Mammography
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MRI Mammography Procedure
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The main component of most MRI systems is a large tube-shaped or
cylindrical magnet
The patient has to wears a wrap and give away any metal object
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: MRI Mammography
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MRI Mammography Procedure
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To begin the MRI exam, the patient is positioned on a special table
inside the MRI system opening. A breast coil is used.
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: MRI Mammography
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Contrast Enhanced MRI
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The method is based on the fact that a carcinoma is usually well
vascularized due to its strong growth. Thus a contrast medium will
quickly accumulate in the tumor
The evaluation essentially consists of finding suspicious regions in
the images, calculating the absorption of contrast-medium in those
regions, and deriving the diagnosis from that data
Without contrast
With contrast
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: MRI Mammography
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Benefits of Breast MRI
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Can image breast implants and ruptures
Highly sensitive to small abnormalities
Used effectively in dense breasts
Can evaluate inverted nipples for evidence of cancer
Can evaluate the extent of breast cancer
Can help determine what type of surgery is indicated (lumpectomy or
mastectomy)
May detect breast cancer recurrences and residual tumors after
lumpectomy
Can locate primary tumor in women whose cancer has spread to
axillary (armpit) lymph nodes
Can spot or characterize small abnormalities missed by
mammography
May be useful in screening women at high risk for breast cancer,
according to recent studies
Ernesto Coto - Institute of Computer Graphics and Algorithms
Background: MRI Mammography
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Limitations of Breast MRI
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MRI takes 30-60 minutes compared to 10-20 minutes for screening
mammography
The cost of MRI is several times the cost of mammography
MRI requires the use of a contrast agent
MRI patients must tolerate any claustrophobia
MRI can be non-specific; often cannot distinguish between
cancerous and non-cancerous tumors
Minimally invasive breast biopsy techniques need to be further
developed to evaluate abnormalities detected with MRI
Advanced MRI techniques are often not available at most centers
(currently available at research centers)
Ernesto Coto - Institute of Computer Graphics and Algorithms
Further work
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CAD Systems and Techniques for
Mammography
Registration
 Segmentation
 Visualization
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Ernesto Coto - Institute of Computer Graphics and Algorithms